Repair of medial canthal web with a skin graft

Webs at the lateral or medial canthus are usually due to shortening of the anterior lamella. Treatment involves lengthening the skin, either using flaps or free skin grafts. In this video, the patient had a medial canthal web after a previous external DCR surgery. The scar is excised and the underlying defect is then repaired with a full thickness skin graft.

A written transcript of this video is as follows:

This is Richard Allen at the University of Iowa. This video demonstrates repair of a medial canthal web in a patient who had a previous external dacryocystorhinostomy. The prevision incision likely extended more superiorly than would be preferred. Various options could be considered including a combination of flaps as seen in another video. In this case, it was decided to excise the area of the vertical shortening and place a skin graft. A 15 blade is used to make an incision around the scar. Webs in general are due to shortening of tissue in the area. At the medial canthus, this can be both horizontal and vertical, but mostly vertical. Westcott scissors are used to excise the area of the scar and the skin. The resulting defect is noted which places the canthus in the correct position. A skin graft will be planned. Telfa is used to make a template of the defect. A retroauricular graft is then harvested and placed into position. The graft is sutured into position with interrupted 5-0 fast-absorbing sutures. The area of the shortening is resolved. 6-0 silk sutures are then placed at cardinal positions. Antibiotic ointment is placed over the graft followed by the bolster on top of Telfa. The bolster is fixated into position by tying the 6-0 silk sutures over it. The patient will follow-up in approximately 1 week for bolster removal and reevaluation.