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. 2015 Oct-Dec;22(4):452-6.
doi: 10.4103/0974-9233.167813.

Upper Blepharoplasty and Lateral Wound Dehiscence

Mohsen Bahmani Kashkouli  1 , Mansooreh Jamshidian-Tehrani  1 , Sahab Sharzad  1 , Mostafa Soltan Sanjari  1
Affiliations

Upper Blepharoplasty and Lateral Wound Dehiscence

Mohsen Bahmani Kashkouli et al. Middle East Afr J Ophthalmol. 2015 Oct-Dec.

Abstract

Purpose: To report the frequency of lateral wound dehiscence (LWD) after upper blepharoplasty (UB), a technique and its outcome to prevent LWD.

Materials and methods: A retrospective review was performed for cases of LWD after UB presenting between 2003 and 2009, and then a prospective comparative study was performed between February 2009 and March 2013. For the comparison, subjects were divided into two groups based on intraoperative assessment of lateral wound tension (same technique and surgeon). Group 1 received 1-3 orbicularis/subcutaneous buried sutures (6-0 polyglactin) before interrupted 6-0 nylon skin closure. Group 2 underwent skin closure only. Subjects, who had re-operation, skin healing disorders, and incomplete follow-up (<6 months), were excluded. P < 0.05 was considered as statistically significant.

Results: There were 14 (14/678, 2%) cases with LWD with a mean age of 36.2 years in the audit (2003-2009). The prospective study included 68 subjects (68/293, 23.2%) in Group 1 and 225 in Group 2. Gender and simultaneous forehead and eyebrow procedures were similar between groups (P = 0.3 and P = 0.4 respectively). Group 1 was statistically significantly younger at mean age of 41.4 years, compared to Group 2 at 56.1 years (P = 0.000). The frequency of LWD significantly (P = 0.04) decreased to 0.3% (1/293).

Conclusion: In the presence of wound tension on skin closure (intraoperative assessment), tension relieving buried orbicularis/subcutaneous 6-0 polyglactin suturing of the lateral UB incision could prevent LWD.

Keywords: Blepharoplasty; Eyebrow Ptosis; Lateral Hooding; Upper Blepharoplasty; Wound Dehiscence.

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Figures

Figure 1
Figure 1
Different degrees of lateral wound dehiscence after an upper blepharoplasty procedure
Figure 2
Figure 2
Upper blepharoplasty marking shows a wider area of lateral skin excision to address the lateral hooding
Figure 3
Figure 3
Wider excision of the lateral skin and preservation of the orbicularis oculi muscle in upper blepharoplasty. The maximum wound tension is in the widest area of the excised skin
Figure 4
Figure 4
Technique of upper blepharoplasty with tension relieving suture: Marking (top-left), skin excision (top-middle), passing the tension relieving buried suture (6-0 polyglactin) from the upper (top-right) and then lower (bottom-left) edge of orbicularis/subcutaneous tissue, appearance of the tension relieved wound (bottom-middle), and final wound after skin suturing (6-0 nylon)
Figure 5
Figure 5
Pre- and post-operative (6 months) photos of the upper blepharoplasty incision using 1-3 tension relieving suture at the lateral wound
See this image and copyright information in PMC

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