Divine R D, Anderson R L
Ophthalmic Surg. 1982 Apr;13(4):283-7.
While one of the most basic techniques in eyelid surgery is the repair of an eyelid defect that involves the margin, many eyelid defects are still poorly repaired; and much confusion still exists in this area. Based upon sound anatomic and surgical principles, we suggest several modifications of classically described techniques: (1) The greyline suture is replaced by a tarsal suture through the meibomian gland orifices to provide a stronger closure and better alignment. (2) All tension of closure is supported by the deep tarsal sutures rather than by the margin sutures to avoid notch formation or unsightly scars. (3) A two-layered closure where orbicularis and tarsus is closed in a single layer is technically easier and gives results comparable to the classically taught three-layered closure. Conjunctival sutures in the tarsal portion of the eyelid are unnecessary and frequently cause corneal irritation. (4) When lid resection is performed, a pentagonal excision rather than a "V" or wedge resection should be used to minimize tension on the margin when closed. We present in an illustrated step-by-step fashion our preferred technique which gives consistently good results.
虽然眼睑手术中最基本的技术之一是修复累及睑缘的眼睑缺损，但许多眼睑缺损的修复效果仍然很差；而且该领域仍存在诸多困惑。基于合理的解剖学和手术原则，我们建议对经典描述的技术进行一些改进：（1）通过睑板腺开口进行睑板缝合取代灰线缝合，以提供更强的闭合和更好的对合。（2）所有闭合张力由深层睑板缝合支撑，而非由睑缘缝合支撑，以避免形成切迹或难看的瘢痕。（3）将眼轮匝肌和睑板单层闭合的双层闭合技术在操作上更简便，且效果与传统教导的三层闭合相当。眼睑睑板部分的结膜缝合是不必要的，且经常引起角膜刺激。（4）进行眼睑切除时，应采用五边形切除而非“V”形或楔形切除，以在闭合时尽量减少睑缘的张力。我们以图文并茂的分步的方式展示我们首选的技术，该技术始终能取得良好效果。
