jerseygirl20
Networker
A. Malignant melanoma of the left prezygoma/zygomatic arch, status post radical resection , 15 October 2013, with reconstructive closure by me 25 October 2013.
B. Mild residual left lower lateral eyelid lid eversion (not ectropion) in a status post large cervicofacial flap reconstructive closure of the melanoma resection surgical defect of (A) above.
C. Mild epiphora associated with (B) above, left eye.
Operation:
A. Functional left lateral canthotomy and canthopexy (canthoplasty).
B. Stage II reconstruction of left lateral lower lid and extended left canthal flap healing site.
C. Total wound length of all procedures (A) and (B) above ? 6.1 cm.
D. Two layer (intermediate) closure of the canthoplasty and Stage II reconstruction of (A) ad (B) above.
DESCRIPTION OF OPERATION: The patient was brought to Main Operating Room #4, transferred to the operating table in the supine position and intraoperative monitoring was connected. She was give monitored anesthesia care. The table was turned 120 degrees. The operative site was visualized under magnification and this was also assessed in the preoperative holding area in the normally fully upright Fowler position and, when comparing to the opposite eye, markings were made for planned canthotomy, canthoplasty and revision closures about the eye area from the previous cervicofacial flap. Injections with 1% lidocaine with 1:100,000 epinephrine were liberally injected in and about the area of all of the above surgery and the patient was sterilely prepped and draped in the usual fashion. After an appropriate waiting period to permit the injectate to take full effect, a left lateral subciliary incision was made. A lateral canthotomy was performed on the left eye, and the subcutaneous tissues were splayed open. Hemostasis was effected throughout the case using high temperature ophthalmic incandescent cautery. Then, blunt dissection was effected in the left superolateral orbital rim region down to, but not deep to the periosteum. The left lateral lower lid tarsal plate was exposed by denuding the overlying skin. The elevation portion of the canthoplasty was performed by employing two separate 4-0 Mersilene sutures, one on the superomedial and one on the superolateral aspect of the left lateral tarsal plate in mattress fashion, pexied to the left superolateral orbital rim periosteum. Adjustments were made to match the lower limbus covering right to left and taking into account the lidocaine injection on the left eye. Exacting reapproximation was made of the lateral palpebral ends of the left eye and these were pexed exactly coplanarly with interrupted 6-0 blue Prolene suture. then, the redundant left lower eyelid reconstruction area was corrected in an anticipated standing cone deformity region to a length of approximately 2 cm. Hemostasis was effected. Then, the left lower lateral canthal skin was superiorized and pexied to the left superior canthal skin and closed in two layers with interrupted 4-0 Vicryl suture in the subdermal layer and then a complex four section closure was effected using a combination of interrupted 6-0 blue Prolene suture in interrupted fashion. Then, the extended lateral canthotomy was closed effecting hemostasis initially and then in two layers of interrupted 4-0 Vicryl and the skin wound margins were closed principally using vertical mattress 5-0 blue Prolene suture. The previous cicatrix from the cervicofacial flap closure was excised as part of this closure of the extended lateral correction of the left lateral canthotomy incision. Excellent set down of the lateral left eyelids onto the globe were observed and equal lower limbus coverage was provided on the left side compared to the right side. All areas were cleansed and dried. Bacitracin ophthalmic ointment was applied. Total wound length was 6.1 cm for all superficial cutaneous closures was identified. The patient was rotated 120 degrees, emerged from sedation and transferred to Phase II Recovery for later discharge home today. There were no intraoperative complication.
Any suggestions would be greatly appreciated.
B. Mild residual left lower lateral eyelid lid eversion (not ectropion) in a status post large cervicofacial flap reconstructive closure of the melanoma resection surgical defect of (A) above.
C. Mild epiphora associated with (B) above, left eye.
Operation:
A. Functional left lateral canthotomy and canthopexy (canthoplasty).
B. Stage II reconstruction of left lateral lower lid and extended left canthal flap healing site.
C. Total wound length of all procedures (A) and (B) above ? 6.1 cm.
D. Two layer (intermediate) closure of the canthoplasty and Stage II reconstruction of (A) ad (B) above.
DESCRIPTION OF OPERATION: The patient was brought to Main Operating Room #4, transferred to the operating table in the supine position and intraoperative monitoring was connected. She was give monitored anesthesia care. The table was turned 120 degrees. The operative site was visualized under magnification and this was also assessed in the preoperative holding area in the normally fully upright Fowler position and, when comparing to the opposite eye, markings were made for planned canthotomy, canthoplasty and revision closures about the eye area from the previous cervicofacial flap. Injections with 1% lidocaine with 1:100,000 epinephrine were liberally injected in and about the area of all of the above surgery and the patient was sterilely prepped and draped in the usual fashion. After an appropriate waiting period to permit the injectate to take full effect, a left lateral subciliary incision was made. A lateral canthotomy was performed on the left eye, and the subcutaneous tissues were splayed open. Hemostasis was effected throughout the case using high temperature ophthalmic incandescent cautery. Then, blunt dissection was effected in the left superolateral orbital rim region down to, but not deep to the periosteum. The left lateral lower lid tarsal plate was exposed by denuding the overlying skin. The elevation portion of the canthoplasty was performed by employing two separate 4-0 Mersilene sutures, one on the superomedial and one on the superolateral aspect of the left lateral tarsal plate in mattress fashion, pexied to the left superolateral orbital rim periosteum. Adjustments were made to match the lower limbus covering right to left and taking into account the lidocaine injection on the left eye. Exacting reapproximation was made of the lateral palpebral ends of the left eye and these were pexed exactly coplanarly with interrupted 6-0 blue Prolene suture. then, the redundant left lower eyelid reconstruction area was corrected in an anticipated standing cone deformity region to a length of approximately 2 cm. Hemostasis was effected. Then, the left lower lateral canthal skin was superiorized and pexied to the left superior canthal skin and closed in two layers with interrupted 4-0 Vicryl suture in the subdermal layer and then a complex four section closure was effected using a combination of interrupted 6-0 blue Prolene suture in interrupted fashion. Then, the extended lateral canthotomy was closed effecting hemostasis initially and then in two layers of interrupted 4-0 Vicryl and the skin wound margins were closed principally using vertical mattress 5-0 blue Prolene suture. The previous cicatrix from the cervicofacial flap closure was excised as part of this closure of the extended lateral correction of the left lateral canthotomy incision. Excellent set down of the lateral left eyelids onto the globe were observed and equal lower limbus coverage was provided on the left side compared to the right side. All areas were cleansed and dried. Bacitracin ophthalmic ointment was applied. Total wound length was 6.1 cm for all superficial cutaneous closures was identified. The patient was rotated 120 degrees, emerged from sedation and transferred to Phase II Recovery for later discharge home today. There were no intraoperative complication.
Any suggestions would be greatly appreciated.