Spontaneous eyelid expansion after full thickness eyelid resection and direct closure

Abstract

Background/aims-Direct closure of eyelid defects gives excellent functional results but is usually restricted to defects measuring less than a quarter of the eyelid length for fear of distorting the palpebral aperture and compromising lid function. The authors have used direct closure in larger defects. The aim of this study was to establish the eVects of direct closure of full thickness eyelid margin defects under tension on the palpebral aperture dimensions. Methods-A consecutive series of patients who had undergone one eyelid, full thickness lid resection repaired by direct closure were identified and invited to have both eyes photographed. The palpebral apertures of both eyes were measured from the photographs by a masked observer. The amount of eyelid resected was recorded from the operation notes. The unoperated palpebral aperture was used as the control. The result were analysed using a paired samples t test. Results-The photographs of 18 patients were included in the analysis. The mean width of excised full thickness lid tissue was 15 mm (range 7-26 mm). The mean vertical palpebral aperture height was 9.2 (SD 1.4) mm in the operated eye as opposed to 9.3 (SD 1.2) mm in the non-operated eye. The mean horizontal palpebral aperture width was 26.1 (SD 1.9) mm in the operated eye as opposed to 26.4 (SD 1.8) mm in the non-operated eye. There was no statistically significant difference between the operated and unoperated horizontal and vertical palpebral measurements. Conclusions-Direct closure of large full thickness eyelid defects is possible in selected patients with excellent functional and cosmetic results. Eyelid tissue expansion occurs spontaneously following direct eyelid defect closure under tension, restoring the palpebral aperture dimensions.

Eyelid basal cell carcinoma: non-Mohs excision, repair, and outcome

“…Our proved good results and experience in direct closure for larger lid defects 7 give us a strong argument against the spurious claim that 4 mm margins prevent direct eyelid closure (fig 4, shows 2 months postoperative results of direct closure). Consideration of ultimate defect size must never compromise the goal of complete, primary, tumour excision.…”

Tie Hard 2- An in-Vitro Comparison of First Throw Tension Holding In Twisted v Straight-First Throws; Using Polyglycolic acid (Dexon S), Polyglactin 910 (Coated Vicryl)

“…Direct lid wound closure under tension after tumour excision is commonly used to provide good functional and cosmetic results in Oculoplastic surgery (Hamada et al, 2005;Thaller et al, 2001). Tying the knot without an assistant to hold the knot prior to a locking throw being applied is difficult because it is only the friction within the knot that prevents it slipping.…”

Principles and Techniques of Eyelid Reconstruction

“…Direct closure may be useful for both partial and full-thickness eyelid defects following tumor excision. The immediate postoperative distortion is temporary thanks to spontaneous tissue expansion brought about by the steady pressure of the displaced globe against the reconstructed eyelid [9]. The surgery is often simple and the functional and cosmetic results can be excellent.…”