Sutures and needles

The main sutures used in oculoplastic repair are:

nylon 6/0

• non absorbable polyamide synthetic fibre

• 10mm reverse cutting needle

• non absorbable protein fibre

• 10mm reverse cutting needle

5/0 and 6/0 Vicryl or Dexon

• polyglactin 910 braided monofilament

• provides wound support for 30 days

• 8mm half-circle spatulated needle

(a)

Figure 2.1 Technique for producing an everted skin wound.

(a) The skin hook (I) pulls the entry site skin edge upwards.The needle trajectory (II) takes a greater bite of tissue in the midsection of the wound (B) than in the superficial section (A) of the flap. The curve of the skin hook (IV) then presses on the exit site skin edge. The needle trajectory (III) takes a greater bite of tissue in the midsection of the wound (C) than in the superficial section (D) of the flap.

(b) This shows the desired roll of tissue produced. Remember: on entry, pull skin edge upwards. On exit, push tissue downwards.

Box 2.1 Instruments for oculoplastic repair

A basic set for oculoplastic repair should include:

• Suction and bipolar cautery systems

• Clarkes, guarded or Barraquers lid

Non-toothed forceps:

speculum

• Moorfields

• Stallard (shoe horn) lid guard

• Desmarres retractors

Haemostats:

• Rollets catspaw retractors

• Spencer-Wells artery forceps

• Gillies skin hooks

• Mosquito forceps

• Squint hooks

• Caliper, rule and marker pen

Straight scissors:

• Sharp-ended

Needle holders:

• Blunt-ended

• Silcocks self-retaining

• Troutman or Barraquers non-locking

Curved Scissors:

• Enucleation

Toothed forceps:

• Westcott spring scissors

• St Martins

• Jayles

Lacrimal:

• Listers

• Hayes seeker/Nettleships dilator

• Adsons

• Bowmans probes

Note: 6/0 Vicryl rapide, which is absorbed in 42 days and which provides wound support for 10 days, is useful for skin closure in children. Vicryl used for skin closure should be undyed to avoid tattooing.

5/0 ethibond

• braided polybutylate coated polyester

• non-absorbable; remains encapsulated in tissue

• 8mm half-circle spatulated needle.

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