Arlt’s operation for ectropion. (Arlt.)
ECTROPION.
This condition is the reverse of entropion, and implies eversion of the margin, or of a considerable portion of a lid, with consequent exposure of its conjunctival surface, which undergoes changes in consequence of which it becomes thickened, contracted, and irritated. Ectropion may possibly be produced by violent orbicular spasm, especially in children, the lids being so tightly shut as to be everted. Ordinarily it is the result of external lesions which produce cicatricial contraction, like burns, or of chronic ulcerative lesions along the palpebral border, such as are met with in tuberculous and syphilitic disease. The lower lid is much more frequently involved than the upper.
For the relief of ectropion plastic operations are practised, usually on the lower lid. The milder cases require a V-shaped incision, its apex downward, with free dissection of the integument up or near to the margin of the lid, by which it is released from the scar tissue which has bound it down. [Fig. 390] illustrates the general principle of such an operation. The lower portion of the V-shaped defect is then brought together with sutures, the triangular flap being fastened in a position much higher than that in which it originally rested.
All of these operations upon the eyelids are included under the term blepharoplasty, of which the above is the most simple. When necessary new flaps may be raised from the temporal region, from the forehead or from the cheek, as may be required, and turned into place, their pedicles being so planned as to carry a sufficient blood supply for nourishment of the same. If this supply be properly provided these operations are practically always successful. It is necessary only to make the transplanted flap at least one-third larger than appears to be necessary, judging from mere size of the defect, for experience shows the necessity of allowing at least one-third for primary and cicatricial shrinkage. A heteroplastic operation is occasionally performed for this purpose, by which the flap of skin is detached from an entirely different part of the body, or from the body of another individual. Skin thus transplanted should be prepared by removal of all of the fat upon its raw surfaces, skin alone being desired and not other tissue. [Figs. 391], [392], [393] and [394] illustrate blepharoplastic operations of various types, which may be modified or made more extensive. These are but a few of the various plastic devices, and are intended to serve merely as suggestions or examples rather than methods to which one is limited.
Fig. 391
Richet’s operation for ectropion. (Arlt.)
Fig. 392