Page 178 - Manual of Equine Field Surgery

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17 4 OPHTHALMIC SURGERIES

c

D

Figure 31-1 Schematic of Lembert sutures placed in Figure 31-2 Schematic of crescent-shaped skin

eyelid. being removed and "bisecting" method of suture place-

ment to close Hotz-Celsus blepharoplasty.

PROCEDURE 31-2, A). One corner of the crescent is grasped
with Bishop-Harmon forceps, and the crescent of

Temporary Eyelid Tacking skin and orbicularis oculi is excised sharply using

Steven's tenotorny scissors. Closure of the surgical

Simple interrupted Lembert sutures are placed to site should be with No. 4-0 monofilament nylon

evert the affected eyelid margin. Lembert sutures or braided silk in a simple interrupted pattern. To

are placed in the eyelid skin such that the most ensure ·appropriate alignment of the curvilinear

distal portion of the suture is approximately 3 mm incisions, the first suture should be placed in the

from the eyelid margin (Figure 31-1). The center of the incision, with subsequent sutures

number of Lembert sutures to be placed will vary placed such that they bisect the area remaining to

by the extent of entropion and the degree of be sutured (Figure 31-2, B to D).

tension necessary to maintain eyelid eversion, but

a minimum of two or three Lembert sutures

should be placed. POSTOPERATIVE CARE

Hotz-Celsus Blepharoplasty Postoperative Care

:
The length of affected eyelid margin and amount Protedion A protective eye cup is recom-
mended for either surgical procedure until sutures
of inward rolling are estimated before the patient are removed to prevent rubbing of the surgical

is anesthetized or local anesthesia is injected. Hair site.

should be clipped and the surgical site prepared Su.ture Removal: Tacking sutures should be left

for aseptic surgery. The surgeon removes a cres- in place for 7 to 10 days but may "cut through"

cent-shaped strip of skin and underlying orbicu- the skin prior to this time. Hotz-Celsus blepharo-

laris oculi muscle of the approximate shape and plasty sutures should be removed in 14 days.

size of the area affected by entropion.8 An incision

is made through skin and underlying orbicularis

oculi muscle 3 mm from, and parallel to, the COMPLICATIONS

affected eyelid margin, using a No. 15 scalpel

blade. A curvilinear incision is made proximal to, Care should be taken to prevent stiff suture ends

and parallel to, the first incision, joining the ends of monofilament nylon from making contact with

of the two incisions to create a crescent (Figure the cornea as such contact will cause corneal