|Year : 1973 | Volume
| Issue : 2 | Page : 82-83
Cicatricial ectropion of the lower lid
SS Singha, Harbhajan Singh
Department of Ophthalmology, Medical College, Amritsar, Punjab, India
S S Singha
Department of Ophthalmology, Medical College, Amritsar, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singha S S, Singh H. Cicatricial ectropion of the lower lid. Indian J Ophthalmol 1973;21:82-3
With rapid industrialisation, faster traffic and mechanisation of farming, the number of accidents in the Punjab, Northern India, has increased tremendously. Although, severe injuries to the ocular adenexa, when the visual apparatus remains in tact are not that common; yet on occasions, it becomes a very laborious and taxing job to restore the cosmetic appearance and protect the functioning eye ball from undue exposure.
The purpose of this communication is to present a case with a very bad injury to the lower lid and below it resulting in a grotesque deformity repaired by plastic surgery.
| Case Report|| |
B. R. 32 M, an agricultural farm labourer was involved in a tractor accident six months back and reported to the hospital in July, 1969.
He had almost a total loss of the lower lid and a lot of scar tissue in this region extending up to the upper lip. The conjunctiva of the lower fornix was pulled down, thus flattening it completely [Figure - 1]. The conjunctiva was keratinised.
STEPS OF OPERATION:
A two stage operation was planned and local anaesthesia was used.
The scar tissue in the region of lower lid was dissected. It was found to be adherent to the underlying bone slightly. The skin as well as the conjunctiva were mobilised as much as possible. Two parallel incisions 10 mm. apart starting 5 mm. below and lateral to the lateral canthus, were started and extended upwards and lateraly for about 30 mm. towards the temporal region in the region of the Crow's foot. Thus, a full thickness, pedicle graft, 10 mm X 30 mm. was formed and its distant end was snipped off. The graft was slided down in the region of the lower lid and stiched with the skin, there, with interrupted stitches. The conjunctiva was stitched to its deeper surface. The wound from where the skin flap was taken was closed by mobilising the adjacent skin. The scar tissue below the lid in the region of the check was also dissected and the skin approximated.
It was carried out two months after the first. The base of the pedicle flap was snipped and the redundant portion of the skin cut off, thus, smoothening the kink of skin which had formed earlier.
An eliptical mucous graft 20 mm X 5-10 mm. was taken from the buccal aspect of the lower lip. The conjunctiva in the lower fornix was dissected. One side of the mucous graft was stitched with the conjunctiva and the other side with the posterior margin of the newly formed lower lid. Two mattress silk sutures were passed from the skin over the lower orbital margin to the fornix, back at the junction of the lateral and medial thirds with the middle. [Figure - 2]. shows the final appearance.
The stitches were removed after 8 days.
| Comments|| |
The aim of all plastic repairs is to try to restore the anatomical structure and the physiological functions as far as possible. Except for the general guidelines, it is not possible to follow any single fixed rule, as every case is an individual problem and has to be dealt with, on its own merits. The method to be adopted has to be planned and executed according to the judgment and experience of the surgeon.
Various types of skin grafts like split thickness, full thickness and sliding have been advocated by Stallard  for the repair of such lesions. The pedicle graft from the temporal region in this case proved very handy and useful. The final appearance, was by and large satisfactory.
| Summary|| |
A case of cicatrical ectropion of the lower lid with almost its total loss was successfully repaired by a pedicle skin graft from the temporal region and the lower fornix was formed with mucous graft from the buccal mucosa.
| References|| |
Stallard, H. B.: Eye Surgery Edition III John Wright and Sons London. Page 221-223. (1958).
[Figure - 1], [Figure - 2]