Case of Bilateral Iatrogenic Medial Canthal Webbing Treated with Full Thickness Skin Grafts

Abstract

A 37-year-old female sustained a domestic facial injury after falling from the stairs. The deep horizontal skin laceration that resulted from the trauma extended over the nasal dorsum, approximately 5mm from each medial canthus. The cutaneous defect was debrided from the crushed nonviable tissue and sutured by a junior doctor in the Accident and Emergency Department. Unfortunately the wound contracted over the following two weeks and the patient presented again to the hospital lamenting a clear cosmetic iatrogenic webbing deformity over the medial canthi. Two months later she was reassessed in order to allow some more time for scar maturation and to plan the surgical treatment (Figure 1,2A&2B). Ideally, it would have been preferable to delay the operation for a longer period of time, but the intense emotional distress experienced by the patient in view of the approaching wedding day, scheduled for the following month, weakened our resistance and it was agreed to proceed with the operation within the next few days.It was felt that the scars were too close to the medial canthi for a Z-or V-to-Y-plasty and an alternative, although uncharted solution for the specific defect was chosen. Two FTSG were harvested under general anesthesia from the left post-auricular matching colored area. The scars were released with a horizontal incision of approximately 7mm and the skin undermined ( Figure 3A&3B). The fat was carefully removed from both grafts and they were fashioned to match the defects and then sutured and secured with cotton bolsters in the usual manner. Fortunately the procedure was successful (Figure 4,5A&5B) and almost more importantly warded off the cancelling of the wedding. AbstractEpicanthal webbing can result from both traumatic and iatrogenic injuries. The latter is usually related to skin incisions required to gain external access to the ethmoidal and frontal sinuses or more rarely to the lacrimal sac. Surgical management traditionally involves a Z-plasty or V-to-Y plasty of the medial canthus to increase the length of the vertical scar, thus releasing the web contraction.These methods, however, may present challenging limitations when the webbing is too close to the medial canthus, since the potential length of one of the plasty limb is greatly restricted by the vicinity of the eye. This case report exemplifies such a scenario, which required an alternative solution with full thickness skin grafts (FTSG).Keywords: Medial canthus; Webbing; Full thickness skin grafts