Indications. It is especially useful for paralytic cases, and as a subsequent measure to the VY operation described below for cicatricial ectropion. The operation is likely to be successful if a marked reduction in the deformity is effected by pulling the skin at the side of the outer canthus upwards.
Instruments. Scalpel, dissecting forceps, artery forceps, scissors, sutures.
Operation. First step. An incision, 2 millimetres below the lid margin and opposite its outer third, is carried through the skin parallel to the border of the lower lid outwards to the canthus; having reached this point the direction of the incision is changed and it is carried more upwards and outwards till the upper end is on a level with the upper orbital margin. The incision is then carried outwards for about 6 millimetres and again downwards, slightly diverging from the former incision, until it is opposite the lower orbital margin. This flap of skin and subcutaneous tissue is dissected up from above downwards (Fig. 152).
| Fig. 152. Argyll Robertson’s Operation for Ectropion. Second step. Showing the method of shortening the lid and the strap of skin reflected. The upper convex line shows the piece of skin to be removed so that the lid may be pulled upwards into position. | Fig. 153. Argyll Robertson’s Operation for Ectropion. Final step. The strap of skin has been sutured in position after pulling it upwards sufficiently to reduce the deformity and enlarging the raw area upwards to allow this to be done. |
Second step. A V-shaped portion is removed from the margin of the lower lid near the outer canthus, the base of the V being of sufficient length to produce the shortening of the lid required when the edges of the incision are brought together.
Third step. The strap of skin is pulled upwards to the extent required to replace the lid in position, and sutured there. The raw area must be enlarged upwards so as to accommodate the upper end of the strap. It is better to do this than to shorten the strap, since a firm hold is thus obtained (Fig. 153).
OPERATIONS FOR THE ACTIVE OR CICATRICIAL FORM OF ECTROPION
The numerous operations which have been devised for this condition are divided into two groups: (1) the transplantation of flaps in the neighbourhood of the lesion, and (2) the grafting of skin flaps from other parts of the body. The latter method is usually only undertaken when the employment of flaps from the neighbourhood of the deformity is impossible, as the cicatricial contraction which follows the grafting of flaps from other parts of the body is usually attended by considerable shrinkage and therefore does not yield such satisfactory results.
BY THE TRANSPLANTATION OF FLAPS
VY operation (Wharton Jones). Indications. This operation is useful for cases of ectropion affecting the middle parts of the lower lid, generally due to a scar such as would result from a healed sinus after tuberculous periostitis of the lower orbital margin.