[MUSIC PLAYING]

LILLY H. WAGNER: So this patient is five weeks out now from an upper lid reconstruction with a Cutler-Beard flap. We're going to separate the flap today. She had a sebaceous cell carcinoma, and there was some residual tumor found at the temporal margin on permanent pathology. So we are also going to excise an additional wedge of tissue temporally, and we're now just marking out the tissues that we're going to excise. And we're just making a full-thickness incision through this flap.

Now our flap is separated, and we can release the lower lid bridge. We have to just freshen up the skin so we can close the defect. Now we're going to excise the additional wedge, and we're going to remove basically just our old scar. So here's our main specimen that will just be processed. We're sending a margin here.

Here's our additional wedge excision with the nasal and temporal margin. So we're going to send off now-- so close our upper lid full-thickness defect. And before we close it, we're just going to resect a little bit of skin. So we're just approximating the new lid margin to this remaining normal lid margin here on the temporal side, about the level of the lash line.

And this is just like we would do a full-thickness repair, except in this upper lid flap, instead of tarsus, we have an acellular dermis alloderm graph that I placed when I did the Cutler-Beard flap. So here's our temporarily tight silk suture. I'll just confirm that it's in a good position before we close. We'll secure our conjunctival edge before we repair that.

So now that we have our margin repaired-- and we have a nice mucosal edge on the margin, and we have our full-thickness defect repair deep-- just place one silk suture in the skin just superior to the margin to be able to tie our tails away from the eye. But we can close this lower defect first now. And we have a little bit irregular edge here, so we're just going to put some interrupted sutures into the lower eyelid.

We can excise a small dog-ear. And for this dog-ear, you just extend your incision. And this concludes our second-stage Cutler-Beard and additional wedge excision for a sebaceous carcinoma of the upper eyelid.

This is a patient that was referred to us for chronic eye irritation and lash loss and was found to have sebaceous cell carcinoma in the upper eyelid. We proceeded to excise this with frozen sections after we confirmed with conjunctival map biopsies that the upper eyelid was the only area that was involved. And this picture shows the eyelid after the initial resection. You can see that about 90% of the upper eyelid is missing. Could reconstruct with a Cutler-Beard flap.

And then here you see the patient one week out after the reconstruction. You can see there's a bridge of tissue from the lower eyelid brought up into the upper lid. The lid margin and tarsus of the lower eyelid remain in place. And today we did the second stage, which is usually done six to eight weeks after the first stage and involves separation of the flap and repair of the incision under the lower lid.

[MUSIC PLAYING]