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C. Li, J. Tao; Temporary, External Suture "Swinging Eyelid" Reattachment. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3146.
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Lower eyelid reattachment at the lateral canthus after a "swinging eyelid" procedure traditionally involves deep fixation of the free tarsus to periosteum with sutures and even wire. Chronic lateral canthus tenderness is not uncommon with buried, permanent material. Absorbable sutures, on the other hand, are associated with granulomas and suture abscesses, in our experience. We surmise that an external, temporary suture may circumvent the problems associated with standard techniques, yet provide adequate re-approximation of the lateral canthus.
24 eyelids in 20 patients underwent surgical reattachment of the lateral lower eyelid tarsus to lateral orbital tubercle with an external suture after a "swinging eyelid"-type procedure. The surgical technique is described in detail. The suture was removed at two to four weeks post-operatively. At a minimum of 8 weeks post-operatively, the patients were evaluated for wound complications such as dehiscence, granuloma, suture abscess, lid malposition, and subjective complaints.
22 of 24 (91.7%) eyelids were successfully re-approximated at the lateral canthus at a follow-up of 8 weeks to six months. 2 eyelids (8.3%) had a wound dehiscence which required surgical intervention due to lid malposition. The subsequent repair was uneventful and successful in these two patients. No other lid malpositions, granulomas, or abscesses were encounterd. One patient (4.2%) described persistent soreness at the lateral canthus.
Surgical reattachment of the lateral lower eyelid tarsus to lateral orbital tubercle with an external, temporary suture was overall effective in this series. This procedure may be considered to avoid problems associated with traditional, buried suture techniques. These advantages are countered by a small, but significant risk of wound dehiscence. Nevertheless, this complication seems amenable to re-closure in standard methods.
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