V-Z procedure for the correction of senile ectropion.

OF the many methods devised for repair of senile ectropion of the relaxed type, the two most widely used are perhaps the Kuhnt-Szymanowski and the Blaskovicz techniques. The former may be performed in two different ways, according to whether the tarso-conjunctival triangle is excised from the middle third of the lower lid (Meller, 1950), or from its outermost part, near the lateral canthus (Elschnig, 1922). The one technique requires a long intermarginal incision, thus creating the possibility of disrupting the lash roots and of producing an unevenness of the lid border; the other may give rise to some deformity of the external commissure. In each case the whole lid is drawn temporally, and an unsightly displacement of the lower lacrimal papilla and punctum can ensue, the more so when the ectropion is confined to the inner segment of the lid. In the operation described by Blaskovicz (1922), a complete section of the lid is removed by means of two parallel incisions, and a sliding skin-flap is fashioned which, owing to the excision of a Burow triangle, serves to hold the lid in its, proper position. According to whether the defect appears predominantly in the nasal or the temporal part of the lid, two variants of the same procedure are used, which differ only in that the resected triangle is located in the vicinity of the ala of the nose or in the temporal region. Although, originally, the apposition of the margins of the surgical coloboma was effected by several carefully placed border-to-border sutures, a much better result may be obtained if a Hughes tongue-and-groove joint or a Wheeler halving is used. In any case, the fact remains that the operation requires a rather extensive dissection and that the scars do not always become as inconspicuous as might be desired. On occasions, too, an epicanthus-like fold over the internal canthus or a downward displacement of the latter may appear as a late complication when the operation is performed on the nasal side. To overcome these difficulties, a procedure has been evolved which consists basically in the excision of a triangular full-thickness segment of the