RU2840184C1 - Method for suturing in lower eyelid plastic surgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to plastic surgery, and can be used for suturing in lower eyelid repair. Continuous intradermal suture is made in the direction from an internal corner of an eye to an external one, positioned under the ciliary margin without a space. In this case, the needle is inserted into the derma of one of the flaps opposite the needle sticking out point on the opposite flap, an interval of the stitch lengths related on the ciliary edge of the incision and on the opposite flap makes 1:3 to 1:7 respectively.

EFFECT: method enables eliminating the risks of eyelash ingrowth and injuries in a combination with reducing the suturing time ensured by a combination of surgical techniques.

1 cl, 5 dwg, 4 ex

Description

The proposed invention relates to the field of plastic surgery, in particular to methods of applying sutures when performing lower eyelid plastic surgery.

Any incisions made during facial surgery, particularly blepharoplasty, are recommended to be closed with a continuous single-row intradermal Halsted suture.

It is this method of suturing that is closest to the proposed invention; it consists of inserting a surgical needle at a distance of 1 cm from the edge of the incision, passing it through the thickness of the dermis, capturing sections of the same length from each edge of the incision in such a way that the place where the needle is inserted from one edge of the incision coincides with the place where it is inserted from the other edge (see G. M. Semenov, V. L. Petrishin, M. V. Kovshova, “Surgical Suture,” St. Petersburg, 2001, p. 33).

However, the technique for performing the known suture in lower eyelid plastic surgery imposes restrictions on the location of the incision, not allowing it to be positioned closer than 1.5 mm to the ciliary margin with the upper subciliary approach (Belousov A.E. "Plastic Reconstructive and Aesthetic Surgery", St. Petersburg, 1998, p. 609), since such positioning of the suture will damage the eyelash bulbs, which will lead to eyelashes falling out or growing in.

Thus, this method of suturing does not allow to make a suturing at the eyelash growth line, i.e. to make the suturing invisible to the patient and others. In addition, the main technical difficulty of making a Halsted suturing is to control the symmetry of the needle insertion and removal, also when suturing it is necessary to constantly control the degree of thread tension, which requires a significant amount of time to make the suturing, and accordingly, the time of the operation increases. Thus, on average, to apply an intradermal Halsted suturing for lower eyelid plastic surgery, the surgeon needs 8±3 minutes.

Thus, the technical problem of the proposed invention is to create a method for applying a suture in lower eyelid plastic surgery, in which it would be possible to position the suture directly under the ciliary edge of the lower eyelid without an indentation and without the risk of damaging the eyelash bulbs to improve the aesthetic effect and which would reduce the time required to apply the suture.

The technical result of the invention is to improve the aesthetic effect of the operation, eliminate the risks of ingrown and damaged eyelashes while simultaneously reducing the time required to apply the suture.

The technical problem is solved by performing a continuous intradermal suture positioned under the ciliary edge without an indentation, while the needle is inserted into the dermis of one of the flaps opposite the needle insertion site on the opposite flap, and the interval of the ratios of the lengths of the stitches performed on the ciliary edge of the incision and on the opposite flap is from 1:3 to 1:7, respectively.

Performing stitches on the ciliary edge of the incision and on the opposite flap of the incision in the range of ratios from 1:3 to 1:7 in such a way that the tissues of the flap are completely stitched and only the skin of the ciliary edge is caught, allows the suture to be placed directly under the ciliary edge, without an indentation, which certainly improves the aesthetic effect of the operation, since the scar after the removal of the suture is invisible, masked by the eyelashes, and also allows to reduce the time of suturing to 3±2 minutes, respectively, to reduce the time of the operation.

It is in the range of stitch length ratios from 1:3 to 1:7 that it is possible to place the suture under the eyelash edge without the risk of damaging the eyelash bulbs; it is also this range of stitch length ratios that allows for a complete alignment of the eyelash edge and the opposite flap, significantly reducing the time required to apply the suture.

When performing a seam with a stitch length ratio of less than 1:3, there is a risk of damaging the eyelash bulbs, and the time required to apply the seam increases due to the increase in the number of punctures and pinpricks.

When performing a seam with a stitch length ratio of more than 1:7, matching the edges of the cut becomes difficult, and it becomes necessary to apply additional adaptive seams, which increases the time required to apply the seam.

Also, due to the smaller number of loops and shorter length of stitches made on the eyelash edge, the suture is removed painlessly and quickly, which has a beneficial effect on the patient’s psychophysical state in the postoperative period.

The essence of the invention is explained by illustrations.

Fig. 1 shows a diagram of the application of a suture using the proposed method.

Fig. 2a, 2b show photographs of the patient (45 years old) before lower eyelid plastic surgery and at an examination 1 month later.

Fig. 3a, 3b show photographs of the patient (42 years old) before lower eyelid plastic surgery and at an examination 1 month later.

Fig. 4a, 4b, 4c show photographs of the patient (62 years old) before lower eyelid plastic surgery, at the examination after 1 month, and at the examination after 1 year and 2 months.

Fig. 5a, 5b, 5c show photographs of the patient (28 years old) before lower eyelid plastic surgery, at the examination after 1 month and at the examination after 3 months.

The method of suturing during lower eyelid plastic surgery is performed as follows.

The needle is inserted outside the incision, positioned strictly under the ciliary edge, from the inner corner of the eye. The needle is inserted 1 mm from the incision edge on the side of the ciliary edge. Then a continuous intradermal suture is made, alternately making stitches 1 on the flap of the lower edge of the incision and stitches 2 on the ciliary edge of the incision in such a way that the place of needle insertion from one edge of the incision coincides with the place of insertion into the opposite flap. In this case, the range of ratios of the lengths of stitches made on the ciliary edge of the incision and on the opposite flap is from 1:3 to 1:7, respectively.

Thus, when performing a suture according to the proposed method, the tissue of the flap is stitched completely, and the skin of the ciliary edge is only hooked.

Example 1.

Patient V., 45 years old (Fig. 2a).

Lower eyelid plastic surgery was performed. The incision was made directly under the eyelash edge without any indentation, and was sutured according to the proposed method.

The needle was inserted outside the incision, in particular, at a distance of 1 cm from the inner corner of the eye. The needle was inserted 1 mm from the edge of the wound on the side of the eyelashes.

Next, the needle was inserted through the middle of the plane of the dermal incision on the opposite flap, the needle was passed through the dermis parallel to the incision edge, making a 6.5 mm stitch, the needle was pulled out through the middle of the dermis of the same incision edge, forming intradermal stitch 1. After that, the needle was inserted opposite the needle puncture site into the skin of the ciliary edge, grabbed, making a 1 mm stitch. Next, the needle was inserted into the inner part of the flap, located opposite the needle puncture from the dermis of the ciliary edge, stitching it, the stitch length was 6.5 mm. After that, the skin of the ciliary edge was hooked, making a 2.5 mm stitch. Next, the flap was stitched, making a 3.5 mm stitch and the skin of the ciliary edge was grabbed, making a 1 mm stitch. After that, the needle was inserted at the outer edge of the flap with a puncture on the skin outside the wound. Then the end of the thread was pulled to align the incision flaps.

During the examination on the 5th day, the suture was removed, the edges of the incision without signs of inflammation. During the examination after 1 month, a high aesthetic effect was noted, the suture was not noticeable (Fig. 2b).

Example 2.

Patient E., 42 years old (Fig. 3a).

The lower eyelid was plasticized, the incision was sutured in accordance with the proposed method. At the examination after 1 month, a high aesthetic effect was also noted (Fig. 3b).

Example 3.

Patient L., 62 years old (Fig. 4a).

Lower blepharoplasty was performed. When applying the suture in the proposed manner, a good cosmetic result was obtained (Fig. 4b, 4c). Example 4.

Patient Ya., 28 years old (Fig. 5a).

Lower eyelid plastic surgery was performed, the incision was sutured in accordance with the proposed method. At the examinations after 1 month and after 3 months, a good cosmetic result was also noted (Fig. 5b, Fig. 5c).

Claims (1)

A method of suturing in lower eyelid plastic surgery, which consists of performing a continuous intradermal suture in the direction from the inner corner of the eye to the outer corner, positioned under the ciliary edge without an indentation, while the needle is inserted into the dermis of one of the flaps opposite the point of needle insertion on the opposite flap, the range of ratios of the lengths of the stitches performed on the ciliary edge of the incision and on the opposite flap is from 1:3 to 1:7, respectively.