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Minimal incision posterior approach levator plication for aponeurotic ptosis.

ABSTRACT: To assess the efficacy and predictability of a minimal incision posterior approach levator plication technique for correction of involutional ptosis.Retrospective chart review of patients with involutional aponeurotic ptosis underwent minimal incision posterior approach levator plication technique between August 2013 and June 2014 by a single surgeon. The upper lid was double everted, and the conjunctiva and Muller's muscle layers were incised vertically until the levator aponeurosis could be identified. The incision(s) was similar to performing incision and curettage of chalazion, except that the site was above the tarsal plate and extended towards the fornix. Then insertion of aponeurosis was dissected away from the anterior tarsal surface, and the more superiorly located levator was plicated on it with double arm suture(s). No tissue was excised in this procedure. Surgical success was defined as a postoperative margin reflex distance (MRD)>2 mm and<4.5 mm, interlid height<1 mm and satisfactory contour.Forty-four lids of 27 patients were included. Preoperative mean MRD was 0.48 +/- 0.56 mm. Severe ptosis of MRD<1 mm was present in 34/44 patients (77.3%). The postoperative mean MRD was 2.49 +/- 0.53 mm, and mean improvement was 2.02 +/- 0.61 mm, which was statistically significant (P<0.001). The overall success rate was 38/44 (86.4%).Minimal incision posterior approach to levator plication was effective for the correction of aponeurotic ptosis with moderate to good levator function.

SUBMITTER: Ng DS

PROVIDER: S-EPMC4816349 | biostudies-other | 2015 Apr

REPOSITORIES: biostudies-other

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Project description:BackgroundIn the past, posterior malleolus fragments (PMFs) commonly have been indirectly reduced and fixed when fragments involve 25% or more of the tibial articular surface, while smaller fragments were left unfixed. The posterior approach has become increasingly popular and allows fixation of even smaller fragments. This study compares clinical outcome for the 2 treatment strategies.MethodsPatients with ankle fractures involving a PMF treated from 2014 to 2016 were eligible for inclusion. Patients were allocated to group A (treated with a posterior approach) or group B (treated with the traditional approach) according to the treatment given. A one-to-one matching of patients from each group based on the size of the PMF was performed. Patient charts were reviewed, and outcome evaluation was performed clinically, radiographically, and by patient-reported outcome measures (PROMs; Self-Reported Foot and Ankle Score, RAND-36, visual analog scale [VAS] of pain, and VAS of satisfaction). Forty-three patients from each group were matched. Median follow-up was 26 (interquartile range [IQR], 19-35) months postoperatively.ResultsThe median PMF size was 17% (IQR, 12-24) in both groups, and they reported similar results in terms of PROMs. Fixation of the PMF was performed in 42 of 43 (98%) patients in group A and 7 of 43 (16%) patients in group B (P < .001). The former group more frequently got temporary external fixation (56% vs 12%, P < .01) and less frequently had syndesmotic fixation (14% vs 49%, P < .01), and they had less mechanical irritation and hardware removal but more noninfectious skin problems (28% vs 5%, P < .01). Median time from injury to definitive surgery (8 vs 0 days, P < .001) and median length of stay (12 vs 3 days, P < .001) were longer in group A.ConclusionComparison of treatment strategies for ankle fractures involving the posterior malleolus showed similar results between patients treated with a traditional approach and a posterior approach.Level of evidenceLevel III, retrospective comparative study.

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Minimal incision posterior approach levator plication for aponeurotic ptosis.

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