The procedure in this video demonstrates a direct brow lift.
This video demonstrates punctal dilation and insertion of a Mini-Monoka stent for treatment of epiphora due to punctal/canalicular stenosis.
This video demonstrates lacrimal probing and irrigation to investigate the anatomy, patency, and functional status of the lacrimal drainage system.
The surgical management of rectovaginal fistulas remains difficult, as they tend to be recurrent and vary widely in location and complexity. We present a case of a 63-year-old woman with a low-lying rectovaginal fistula who initially underwent chemoradiation and a Low Anterior Resection for a low-lying rectal cancer. Her course was uneventful until two years post-operatively, at which time her anastomotic staple line became stenotic with associated bleeding. This was initially addressed by Gastroenterology who executed a dilation and achieved hemostasis with Argon Plasma Coagulation. This remedied the stenosis, however, it was complicated by the formation of a rectovaginal fistula. Due to the low-lying location and its presence in an irradiated field, a transvaginal approach with an interposed gracilis flap was elected for repair.
In this video, we present a case of levator palpebrae resection in an 8-year-old patient with right eye ptosis.
In the pre-op photo, significant ptosis of the right eye can be appreciated. An incision was planned along the lid crease. 0.1 ml of 1: 100,000 epinephrine was injected. An incision was made by electro-cautery along the lid through the skin and orbicularis. Westcott scissors were used to further dissect horizontally. The septum was identified and opened. The preaponeurotic fat was identified and lifted, and the levator aponeurosis was identified. The levator was then tagged with two 6.0 Vicryle sutures, and isolated from surrounding tissues. Next, three6-0 Mersilene sutures were run from the upper tarsus to the levator. They are tightened with releasable notes. The lid elevation and contour were evaluated and adjustments were made until contour and height were equal and appropriate. The temporary surgical knots were transitioned into permanent surgical knots. Approximately 14 mm of excess levator was then excised. Next, three lid crease formation sutures were placed using 6-0 Vicryl. These were attached to the subcu-skin and levator to recreate the upper eyelid crease. Skin closure was performed with 6-0 fast-absorbing gut sutures. In this one-week post-op photo, the ptosis of his right eye was improved.
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Prior to surgical incision, antibiotic prophylaxis is administered with appropriate intravenous antibiotics. The skin is incised and the posterior incision dissection is done perpendicular, straight down, through the subcutaneous fat. After the skin is incised, the dissection is beveled outward anteriorly. This creates a subcutaneous flap anteriorly. At all locations, the dissection is done down to, but not violating, the clavipectoral fascia. Anteriorly, any axillary creases or folds are obliterated by scoring of the subcutaneous tissue. The axillary breast tissue is then excised, marked for appropriate laterality, and submitted for permanent pathology. The resulting void is copiously irrigated and hemostasis is ensured. Long acting anesthetic is used to infiltrate the regional sites for postoperative analgesia. A 15-French Blake drain is placed posteriorly through a separate stab incision. The skin edges are meticulously aligned at the anterior and posterior edges with redundancy kept in the middle (Figure 6). The incisions are closed in two layers. An absorbable suture is used in interrupted buried fashion followed by an absorbable subcuticular stitch. 2-octyl cyanoacrylate liquid adhesive and self-adhering mesh (Dermabond Prineo) is placed superficially. Video 1 summarizes the technique.
The procedure in this video demonstrates a lower lip sling suspension technique for isolated marginal mandibular nerve palsy using bidirectional fascia grafts.
This video highlights the surgical nuances of rectus abdominis myocutaneous free flap harvest.