Repair of Exposed Silicone Frontalis Sling
Transcript
Saving an infected implant is difficult. In this video, the patient has an exposed, colonized silicone frontalis sling. I believe that the prognosis for saving the sling is low, and usually give the patient the option of one try to save it, versus removal, letting it heal, then placing another one another day. Sometime you get lucky and the tracts of the sling have apparently scarred and you still get elevation of the lids. Sometime, as in this case, you get really lucky and you save the sling.
This is Richard Allen at oculosurg.com. This video demonstrates the rare instance in which an exposed, colonized frontalis sling is cleaned, reposited, and retained by the patient postoperatively. The patient is over 3 years out now and has not had another exposure. The exposed sling is demonstrated. A needle holder is used to grasp the ends of the sling and prolapse it through the incision. The sleeves that were placed around the sling and fixated into position with Mersilene suture are prolapsed forward and a needle holder is placed under the inferior sleeve. Although I like Mersilene, it will be removed in this situation as it is a foreign body. The superior sleeve is removed and then the additional Mersilene suture is removed. The sling and area are then scrubbed with betadine. The area is then widely undermined with a hemostat, and additional betadine is used to irrigate the area. The sleeve is then tightened to place the upper eyelid height at an appropriate position. Additional irrigation is performed with betadine. A knot is then tied with the ends of the silicone above the sleeve. I would hesitate to place a permanent suture in this area. The residual sling is cut. Additional irrigation with betadine is performed. The incision is then closed with superficial 5-0 fast absorbing sutures placed in a vertical mattress fashion. I am hesitant to place any buried suture in this situation. Wound glue (cyanoacrylate/Dermabond) is then placed over the area to seal it.
