Repair of Lateral Canthal Defect

This is Richard Allen at the University of Iowa. This video demonstrates repair of a lateral canthal defect. Repair of this defect will take advantage of shortening the posterior lamella in order to gain anterior lamellar redundancy. This is especially useful with anterior lamellar defects.

The defect is noted, and a lateral canthotomy is performed, followed by an inferior cantholysis. A lateral tarsal strip is fashioned by dissecting between the anterior and posterior lamellae for approximately one centimeter. The mucocutaneous junction of the posterior lamella is excised. The posterior surface of the strip is scraped, and the strip is shortened. The strip will be sutured to the lateral orbital rim at the level of Whitnall’s tubercle with a double-armed 4-0 Mersilene suture on an S-2 needle.

By doing this, the posterior lamella is shortened, which then enables the defect in the anterior lamella to be negated. In other words, by shortening the posterior lamella in relation to the anterior lamellar defect, there is no dissociation in length between the anterior and posterior lamellae.

The strip of lashes is excised. A deep suture is placed with 4-0 Vicryl in a buried fashion. As noted now, there is little tension on the anterior lamellar closure. The anterior lamella is then reassociated with the lateral tarsal strip in order to prevent a web. This is performed with 5-0 fast-absorbing suture.

The skin can then be closed with 5-0 fast-absorbing sutures placed in a combination of interrupted and horizontal mattress sutures. At the conclusion of the case, the defect is repaired with minimal tension on the wound.