Losses of portions of the lid margins usually result from operations for malignant growths. When the loss is in the upper lid, some modified form of Fricke’s operation is the best method of remedying the deformity. When a large area is to be covered, transplantation of a flap from the arm by the Tagliacotian method has to be performed (see Vol. I, p. 679).
Fricke’s operation is also applicable to the outer portion of the lower lid. When the inner end of the lower lid is affected, De Vincentiis’ operation yields satisfactory results. When the whole lower lid has been lost, a modified Dieffenbach’s method with the use of the ear cartilage is indicated.
De Vincentiis’ operation. The operation aims at shifting the remains of the lid bodily inwards to cover the gap left by the removal of the growth.
Instruments. Scalpel, dissecting forceps, artery forceps, scissors, sutures.
Operation. First step. The portion of the whole thickness of the lid together with the growth is excised by a V-shaped incision (Fig. 159).
| Fig. 159. De Vincentiis’ Operation to replace the Loss of the Inner Portion of the Lower Lid. Showing the inner portion of the lid removed by a V-shaped incision and the relief incision made outwards from the external canthus. | Fig. 160. De Vincentiis’ Operation Completed. The lower lid has been pulled inwards and united to the opposite side of the gap left by the V-shaped incision. The incision outwards from the outer canthus, now much diminished in length, is also sutured. |
Second step. The outer canthus and orbito-tarsal ligament are divided with the scissors. The incision is then carried outwards and upwards with a scalpel, in a line with the lower margin of the lid, the incision being long enough to free the lower lid sufficiently to slide it inwards and to enable the edges of the V-shaped wound to be united (Fig. 160).
Dieffenbach’s operation (modified with the use of ear cartilage). This operation consists in shifting inwards a flap of skin and subcutaneous tissue derived from the outer side of the face to take the place of the eyelid which has been removed, the conjunctiva and tarsal plate being represented by a piece of skin and cartilage taken from the posterior surface of the ear and stitched to the inner surface of the flap.
Operation. First step. The growth, together with the eyelid, is first removed by a V-shaped incision, the base of the V being formed by the margin of the lower lid.