Download Oak Park Surgery Center 860 Oak Park Blvd., Suite 102 Arroyo

Oak Park Surgery Center
860 Oak Park Blvd., Suite 102
Arroyo Grande, CA 94320 ♦ (805) 474-6383
OPERATIVE REPORT
PATIENT NAME:
MEDICAL RECORD NUMBER:
DATE OF SURGERY:
SEYMOUR, CARL
0015855
June 21, 2016
SURGEON:
ASSISTANT:
ANESTHESIOLOGIST:
ANESTHESIA:
ROBERT W. HIGGINBOTHAM, M.D.
NONE
NOLAN HIGA, M.D.
MONITORED ANESTHESIA CARE PLUS LOCAL
PREOPERATIVE DIAGNOSIS:
1. Cicatricial ectropion, Right Lower Eyelid.
POSTOPERATIVE DIAGNOSIS:
1. Cicatricial ectropion, Right Lower Eyelid.
OPERATION PROPOSED AND PERFORMED:
1. Ectropion repair by a Kuhnt-Szymanowski procedure, with autograft skin graft from
Right Upper Eyelid to Right Lower Eyelid for eyelid reconstruction, Right Lower
Eyelid.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: After the patient was prepped and draped in the usual
sterile ophthalmic manner over the entire eye, including both upper and lower eyelids, the
patient was draped in the usual sterile manner over the operative eye. A sterile marking pen
was used to mark an infraciliary incision along the lower eyelid starting at the punctum and
going temporally approximately 1 cm beyond the lateral canthus and then angled
inferotemporally in one of the crow’s feet wrinkles. A long 27-gauge needle was used to inject 5
cc of 2% Xylocaine and 0.5% Marcaine with bicarbonate into the right lower eyelid, both through
the conjunctival approach and through the subcutaneous approach. A Bovie setting of 12 was
used to cut through the pre-marked incision area both infraciliary and inferotemporal. Then
using a 0.3 forceps, the angled flap that was created at the apex approximately 1 cm to the
lateral canthus was then elevated. The Bovie was used to undermine the skin and muscle flap
going inferonasally. Once adequate space was obtained, all bleeders in the orbicularis muscle
were cauterized. At this point, 0.3 and 0.5 Castroviejo forceps were then used to overlap the
internal portion of the lower eyelid. After ascertaining the amount of the wedge resection to be
removed, the ends of the two parts of the incision were marked along the gray line of the right
lower eyelid. A Chalazion clamp was then placed over this area, and the Bovie was used to cut
through the tarsal plate, down 4 mm in both marked sites. Each of these incisions were then
angled together to create an inverted wedge resection.
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Oak Park Surgery Center
860 Oak Park Blvd., Suite 102
Arroyo Grande, CA 94320 ♦ (805) 474-6383
OPERATIVE REPORT
PATIENT NAME:
MEDICAL RECORD NUMBER:
DATE OF SURGERY:
SEYMOUR, CARL
0015855
June 21, 2016
Once the tarsal plate orbicularis inverted wedge was removed, the surgeon used the 0.3 and
0.5 Castroviejo forceps to bring the incision lines close together while the assistant was first
loosening and then re-tightening the Chalazion clamp. Approximately six interrupted 6-0 Vicryl
sutures were then used to close the wound, first going through the tarsal plate for two sutures,
and then using a gray line suture along the inferior lid margin with the ends of the suture left
long. Upon tying the lower incisions, the long ends were incorporated into the next two sutures
going inferiorly. The balance of the interrupted 6-0 Vicryl sutures were carried inferiorly through
the orbicularis and subconjunctival spaces. Then a 6-0 Vicryl suture was used to close the
inferotemporal part of the incision in the crow’s feet wrinkle. Next, the measurement was taken
for the length and the width of the graft tissue that would be necessary to allow the inferior lid to
be released in excellent apposition with the globe.
Another incision was then marked along the superior tarsal plate for the length of the skin that
was necessary, and for the width, which was approximately 5 mm. This was tapered at each
end, and then the subcutaneous tissues were injected beneath the pre-marked excision site.
The Bovie was then used to excise this extra skin and the graft material was placed into the
infraciliary incision with the central part of the skin thickest at about 5 mm, tapering at each
edge. Two 6-0 Vicryl running sutures were then used to close on each side of the new graft
material. The upper eyelid incision was then closed, also using a 6-0 Vicryl running suture.
At the completion of the procedure, the patient tolerated the procedure well and was returned to
the recovery room in satisfactory condition.
_________________________
Robert W. Higginbotham, M.D.
RWH/mes
D: 06/22/16
T: 06/24/16
Tracking #: WS373122
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