The surgical repair of vertical full-thickness lacerations of the eyelids continues to intrigue ophthalmologists. Avoiding postoperative notching at the lid margin has been the major objective. Notching not only produces a cosmetic deformity, it can also result in lashes and skin being turned against the globe in the area of the notch.
Mechanism of Notch Formation
Notch formation, after full-thickness lid lacerations, probably results from three factors: (1) the orbicularis muscle normally contracts in the direction of its insertions overlying the medial and lateral canthal ligaments. When the lid is divided vertically, the contractions of the orbicularis tend to pull the edges of the wound apart, producing a thinning and notching of the margin. (2) During healing of the laceration, scar contracture occurs in the vertical direction. This vertical contracture produces a force pulling away from the margin which produces a notch. This vertical force can be neutralized by a
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