ABSTRACT
Procedure The patient is positioned in sternal recumbency with the head slightly elevated and turned to give good exposure of the surgical field. The lesion to be removed is highlighted in the skin of the lower eyelid using blue ink (247). The lesion is then excised, creating a large, full-thickness eyelid defect (248). The incision path for the H-plasty consists of two slightly diverging lines that extend from the ventral
This is a relatively simple technique that can be used to reconstruct a very large portion of the upper or lower eyelid, including parts of the lateral canthus. Superficial eyelid defects or full-thickness defects may be reconstructed using this technique. Recon - struction of large defects of the upper eyelid may result in impairment of the blink response. In addition, as peripheral skin is used, trichiasis is a potential complication. When repairing large fullthickness defects, the surgeon must remember that no conjunctival lining is provided unless additional
Burrow’s triangles are incorporated into each in - cision line, with the point of each triangle being away from the incision line. The side of the triangle that runs along the incision line is at least the same length as the distance the flap must travel to cover the defect (249). The triangles are removed and the flap is dissected with care from the tissues below using scissors. The surgeon should ensure that the flap is capable of moving freely and will cover the defect with no tension (250-252). The flap is secured into position by placing sutures in the angles
Positioning of the graft should allow for at least 1 mm of graft to protrude from the eyelid margin into the inter palpebral fissure (253). The flap is now secured at the palpebral edge in two layers. First, a suture of absorbable material is placed in the subcutaneous plane with a buried knot. The first bite (as shown in 254) is taken in the right side of the graft as it travels in a proximal to distal direction. The needle is then redirected to engage the opposite side of the wound and create a bite that travels in the opposite direction.
