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A full thickness lid resection was performed of the right lower eyelid consisting of approximatley 80% of lower eyelid down to the orbital rim. Medial margin returned positive and addition section was removed, which came back negative.

The tarsal conjunctival pedicle flap from the right upper eyelid to the right lower eyelid was fashioned with removal of approximately 70% of the right upper lid tarsal plate. Conjunctival pedicle flap was then secured in position through the capsular and palpebral fascia. The fascia was identified at the orbital rim. Multiple 5-0 Vicryl was then used to secure the tarsal graft and tarsal plate from the conjuntival pedicle flap. This was secured and then the skin was harested from the left upper lid in standard graft incision. The skin graft was then deatted, transfered over and multiple 6-0 fastin used to secure the graft. Medial canthal reconstruction also was reconstructed, reconstucting the medial canthal tendon ligament over to the tarsal plate and this was performed and secured in position with 5-0 vicryl. The canalicular system need to be sacrificed in the midst of extensive and invasive cancer. Reconstuction of the canalicular system was not performed in this setting. A Frost suture tarsorrhaphy was performed over a Xeroform and sterile foam pledget. A pressure pack was placed over the eye.

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67973 E4
67950 RT
67840 E4