Erick D. Bothun, M.D., is a pediatric ophthalmologist and strabismologist at Mayo Clinic in Rochester, Minnesota. A pediatric patient with esotropia is in need of a bilateral medial rectus recession. Watch Dr. Bothun perform the procedure while demonstrating a regular fixed attachment and hang-back technique.
mm hmm, mm hmm. So we're gonna do a bilateral strabismus repair for this child. Mr. Business repair both eyes for S. A. Trope. Eah, so this will be a BMW on the right side for Nick's wounds are best placed inferior early here, about eight back. In this case, I'm starting in fairly. I'll try to do the majority of the muscle passing partial thickness from just more than the center line to the inferior. I am about a millimeter above the insertion. I come back with the fellow hand from back to front. Here, I can place this and exposed nicely and do a full thickness pass from back to front. I pull both ends of the future to make sure that lock bite is quite secure. And then we're going to go to the opposite side again coming out a millimeter above the square which is on the top part of that hook. So now I'm making that pass. I come through. I grabbed my suture and pulling it right down on top of the muscle. At this point, the muscles implicated and we're gonna take it off the eye and go all the way across. Watch your content table to make sure we don't trim that. And I'm gonna reattach this with a caliper Now at five millimeters behind the insertion. I will expose that spot of depression where I made with the caliper. Make a small pass and press onto this clara. And I will go back in at this point and there's my mark, aim for the other suture in that direction. Pulling the muscle up to the position that was at 5 mm recessed, throwing square knots down a second, a third and 1/4 at this point. There's different ways of massaging a tenant's wound back into place whether you use an instrument or use a Q tip and we've completed the first eye on the second side, they'll do what's called a hang back technique, virtually identical on the other side. Small hook and a large hook passing directly behind, rotating up to the limits. We have the entire muscle, but you just want to have a nice bear square here, especially if you're gonna wanna hang back. We'll clean off the muscle any dissection you do. You want to stay right on the muscle belly and in this case we're doing a different attachment. So this is what's called a hang back and pass the suture now in front, in the square, in front of the muscle, at the exact location of the original insertion caliper can be set on the same distance you want the muscle to be located behind the original insertion. The same suturing technique coming down just on top of the needle holder so we can take off the top clamp, slide the muscle up underneath, pull the cons down and we've finished bilateral medial rectus recession, one was tutoring into the school era, the second with the hang back and a beautiful case. Thank you