Techniques available in reconstructive surgery of the eyelid.

Reconstructive surgery of the eyelids is undertaken in cases in which lid restoration is indicated after the excision of tumours, or after injury, or because of congenital abnor- malities.Utilization of the avulsed flap is recommended after trauma if this is at all feasible.The repair should be performed as soon as possible, but reasonable delay is no contra- indication and a successful take with a time lapse of up to 36 hours has been seen at this clinic in the current year.Figs i and 2 illustrate the preoperative and postoperative features of a case treated by Dr. Alston P. Callahan, in which I2 hours elapsed before the avulsed flap was replaced. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~1When excision of eyelid structure is indicated, the surgeon should remember that up to one-third of the horizontal dimension can be sacrificed with impunity.Manipulation of the temporal portion with a skin hook allows the surgeon to estimate if undue tension will be present on the suture line.In such circumstances cantholysis (Figs 3, 4, and 5) may be performed by direct exposure, or by the indirect method which produces added flexibility, allowing the incision to be closed adequately.By this tech- nique, a wedge of up to IO mm. in size has been resected and closed adequately.Closure is effected by inserting buried interrupted 6-o silk sutures in the pre-tarsal fascia (Fig. 6).Three sutures of similar size are used in the intermarginal strip.The first approximates the posterior margin and the second the anterior border; the third suture controls the accurate alignment of the grey line.The needle of each suture should emerge through the lid substance about 2 mm.from the line of incision.Before completing the tie on the second suture, the other tied border sutures are passed through this to avoid postoperative abrasion of the cornea.The accurate approximation of these three sutures guarantees a successful surgical result.Finally, the skin incision is closed with fine silk or chromic catgut.