Semicircular Flap Closure of Beyer Machule et al 1993

Larger defects involving up to one-half of the lid margin can be closed by advancing a semicircular skin flap medially (Fig. 9.2a). The lid margin is sutured first (see also Fig. 9.1). Next the tarsus and orbicularis

Fig. 9.1 Direct primary closure of an upper eyelid defect involving up to one-fourth the length of the lid margin (approximately 8 mm).

a The lid margin is closed with 6-0 or 7-0 PDS sutures. The tarsus and orbicularis muscle are then approximated with interrupted 6-0 absorbable sutures. b Continuous 7-0 monofilament suture. The ends of the adjacent deep intermarginal sutures are tied on the anterior lid margin to prevent them scratching the eye. Traction sutures are left long and taped to the cheek.

Fig. 9.2 Lateral semicircular flap closure of an upper eyelid defect involving one-fourth to one-half the length of the lid. a A lateral canthotomy of the upper palpebral ligament is performed to facilitate advancement of the lateral skin. b All the wounds are closed (see Fig. 9.1 ). The same technique is used in the lower lid.

Fig. 9.2 Lateral semicircular flap closure of an upper eyelid defect involving one-fourth to one-half the length of the lid. a A lateral canthotomy of the upper palpebral ligament is performed to facilitate advancement of the lateral skin. b All the wounds are closed (see Fig. 9.1 ). The same technique is used in the lower lid.

muscle are approximated with 6-0 interrupted Vicryl sutures Ethicon, Hamburg-Norderstedt, Germany, and the skin is closed with 7-0 interrupted monofilament sutures (see Fig. 9.1a, b). The lid margin is approximated with three stay sutures, two of which are placed deeply (close to the eyeball) and one more superficially (Beyer-Machule and Riedel 1993). Large upper lid defects are rare and should be repaired only by surgeons experienced in eyelid surgery.

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