Frontalis suspension by a minimally invasive “harvesting-stripping technique” for congenital blepharoptosis in children under 3-years-old

Abstract

Purpose To describe a minimally-invasive “harvesting-stripping technique” on a small segment of autogenous fascia lata (AFL) in small children with severe blepharoptosis under 3-years-old. Methods A single-surgeon, uncontrolled surgical trial was designed for 25 eyelids of 18 small children (5 girls, 13 boys) with severe blepharoptosis. Single- and short-skin incisions (2-cm) were made on the thigh and a final 3X0.6-cm or 3.5X1-cm AFL segment was excised according to the ptosis laterality. The surface area of the harvested AFL was calculated and dissected for a final 9-cmX2-mm-long fascial strip for each eye. Functional and aesthetic outcomes of the upper eyelids were evaluated and the feasibility, effectivity and advantages of this novel approach in younger patients were assessed. Results The mean age was 28.3 months (17–35) with a mean follow-up of 34.3 months (6–96). All eyelids achieved good or excellent functional and aesthetic results (except one), with no peri- or post-operative severe complications such as haemorrhage, wound infection, hypertrophied thigh scar, muscle prolapses, eyelid contour abnormalities, ptosis recurrence or overcorrection. Conclusions “Harvesting-stripping technique” with the AFL may be an alternative approach to correct severe upper blepharoptosis in small children under 3-years-old, which offers various benefits over conventional methods with non-autogenous materials.

Surgical Outcomes After Frontalis Suspension Using Expanded Polytetrafluoroethylene Sling for Congenital Ptosis

“…Some providers, such as Crawford, believe that an autogenous fascia lata material is not a good option in patients younger than three years old, stating that this tissue can be difficult to harvest and that when it is able to be successfully harvested, the amount of material is frequently not sufficient for successful operation [ 11 ]. Other providers, such as Evereklioglu, have reported good functional and aesthetic results with autogenous fascia lata with recent advanced surgical techniques [ 12 ]. Though autogenous fascia lata may provide good results, this technique inevitably requires a second surgical site, which may lead to other unnecessary complications and recovery for the patient.…”