Instruments. Dissecting forceps, scalpel, artery forceps, sutures.
| Fig. 154. VY Operation for Ectropion of the Lower Lid due to a Scar. First step. Showing incision. | Fig. 155. VY Operation for Ectropion. Final step. Showing the lid in position. |
Operation. The operation is performed under a general anæsthetic. A V-shaped incision, with the apex downwards, is made to embrace the whole margin of the lower lid. The upper ends of the V should skirt the outer and inner canthus and roughly lie over the lower orbital margin, enclosing the scar, the apex of the V falling rather below the orbit. The incision should include the skin and subcutaneous tissue. The V-shaped flap is dissected up and the lid liberated from the underlying scar tissue. The incision is then sewn up in the form of a Y (Fig. 155). Temporary tarsorrhaphy (see [p. 266]) is always desirable. Subsequent shortening of the lid margin by the Argyll Robertson method is sometimes necessary.
Denonvillier’s operation. This procedure is useful to remedy an ectropion of the outer portion of the lower lid by the transposition of flaps at the outer canthus.
Instruments. Scalpel, dissecting and artery forceps, scissors, sutures.
Operation. The operation is performed under a general anæsthetic.
First step. An oblique incision (Fig. 156), starting from below the inner end of the deformity, A, is carried outwards and slightly upwards for 12 mm. to the point B. From the point B a curved incision B C is carried upwards to and along the orbital margin. This marks out a triangular flap. From C the incision is carried outwards and downwards in a curved direction to D, which is situated about 2 cm. from the external canthus, thus marking out another triangular flap B C D.
| Fig. 156. Denonvillier’s Operation for Ectropion of the Lower Lid. By reversed flaps at the outer angle. First step. The flap B C D is brought down to form the outer part of lower lid. | Fig. 157. Denonvillier’s Operation for Ectropion. Showing the operation completed after transposition of the flaps. |
Second step. Both flaps are dissected up, and, when all bleeding has ceased, the apices of the triangles are transposed and sutured in position, the incision thus forming a Z-like figure (Fig. 157). A canthorrhaphy is generally required.
Fricke’s operation. This has for its object the transplantation of flaps from the side of the forehead or face into the lid to remedy a loss of tissue resulting from operation or cicatricial contraction.