Wolfe Method.—An incision is made parallel to the tarsal border just below the lashes. The scar tissue is then excised. The palpebral fissure is closed by several sutures, as already described, thus drawing up the everted portion and bringing the lids together and causing a large, open wound ([Fig. 93]).
After the hemorrhage has been controlled a piece of skin about one third larger than the defect is taken from the arm or temporal region of the patient. Next its reverse side is freed of all adipose tissue. It is then laid upon the freshly made open wound, covering it completely, and held in place by numerous fine silk sutures fixing it along the wound margin, as shown in [Fig. 94].
Fig. 93. Fig. 94.
Wolfe Method.
There is more or less contraction of the flap, although primary union takes place. Less contraction of the flap is obtained in the Wolfe method when the subcutaneous fat is not removed, as mentioned above (Hirschberg).
Thiersch Skin-grafting Method.—To somewhat overcome the contraction of the single-graft operation of Wolfe, the Thiersch skin-grafting method may be resorted to as already described. Better results have been obtained with this method. The graft should be placed parallel to the tarsal border. A number of Reverdin grafts can be taken from the temporal region, just below the hair line, and used to cover the wound. These small grafts must be placed quite close together to obtain the best result (Von Wecker). Immobility of the lid is, of course, necessary, and the temporary fixation of the lid must be accomplished as already described. Contraction in this, as in any other skin-grafting methods, is to be looked for and remedied later by minor plastic operations.
Fricke’s Method.—The best results in blepharoplasty, after the extirpation of tumors, are undoubtedly obtained by Fricke’s method. A flap is obtained from the temporal region, with its base in line with the inferior border of the defect to be covered. The flap must be cut to about twice the size of the bared surface, because of the contraction that follows in healing, and also to permit of covering the defect in its longest diameter when twisted. The flap should be taken from the tissues at the outer angle of the eye and cut in the curved form depicted in [Fig. 95] to overcome its distortion as much as possible in twisting. It is twisted upon its pedicle at an angle of 90° and sutured into the defect, as shown in [Fig. 96].
