By Thomas C. Spoor

This booklet is a realistic, problem-orientated advisor to the administration of universal oculoplastic and orbital problems, and offers simplified ideas to complicated difficulties. this article covers higher and reduce eyelid surgical procedure and service in addition to orbital surgical procedure, and the prevention and remedy of capability problems. With fantastic color surgical photos and illustrations, Atlas of Oculoplastic and Orbital surgical procedure is key studying for ophthalmologists, oculoplastic surgeons, neuro-ophthalmologists and plastic surgeons.

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As the 48 assistant applies gentle pressure to the globe, incise the medial fat pad capsule with the hot Ocutemp™ cautery. The white orbital fat will egress from the capsule and may be clamped, cauterized, inspected, and released (Fig. 9) without causing excessive bleeding. Only clamp, cauterize, and remove the medial fat pad that egresses from the capsule. Do not aggressively pull on the fat or reach into the orbit in an effort to remove excessive fat. The superior oblique tendon and trochlea lie deep in the fat pad, and although difficult to damage, when damage occurs it results in a very unhappy patient with diplopia that may be very difficult to treat.

27 The skin graft size is determined with a Telfa template. The eyelid defect is retracted with the traction suture (A), a piece of Telfa is placed on the defect, size is marked by blood, and the template is cut to size (B). The template is outlined on the donor site (C, D). The donor graft is incised with a sharp blade and filleted with a #11 blade (E) or excised with scissors (Fig. 26). 29 Close the donor site (Fig. 26) with interrupted 4-0 silk sutures in a far-far/near-near fashion. 28 These skin grafts must be meticulously thinned.

When the sawing motion is no longer effective or becoming destructive, excise the remaining graft with scissors. A supraclavicular graft may be obtained in a similar fashion and excised with sharp scissor (Fig. 26). The #11 blade sawing technique is not always feasible in the supraclavicular region. Rotating the head and stretching the supraclavicular region facilitates the sawing technique. It is worth the effort since the resultant graft will be thinner and less skin graft thinning will be necessary.

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