title: Figure-of-eight vertical mattress suture technique for anterior flap suspension to overlying tissues in external dacryocystorhinostomy.
abstract: OBJECTIVE
  To describe figure-of-eight vertical mattress suture technique in external dacryocystorhinostomy for a combined one-step closure of anterior mucosal flaps and overlying wound tissues and to evaluate its effectiveness on surgical outcome.
  
  
  METHODS
  A prospective, single surgeon, uncontrolled, interventional case series.
  
  
  METHODS
  A total of 112 consecutive lacrimal drainage systems of 106 patients (84 women, 22 men; 100 unilateral, six bilateral) from June 2002 to January 2006 with acquired nasolacrimal duct obstruction without canalicular disease underwent external dacryocystorhinostomy with this modified technique. Relief of epiphora and anatomic patency were defined as success. Operative time and success rate were evaluated and advantages were stressed and compared with our previous reports.
  
  
  RESULTS
  Mean age was 40.1 years (range, 6 to 75). The etiology was idiopathic in 109 patients and traumatic in three cases. Of 112 lacrimal drainage systems, epiphora was the presenting symptom in 88, combined epiphora and recurrent dacryocystitis in 15, and combined epiphora and mucocele in nine cases. Seven lacrimal drainage systems were revision cases. Mean follow-up was 26.3 months (range, 6 to 48). Success rate was 99.1% (111/112) and mean operative time was 38.2 minutes (range, 28 to 69).
  
  
  CONCLUSIONS
  Such a modified suture technique reveals a rapid and simultaneous one-step closure of two different layers that speeds up surgical procedure; simplifies closure process as the knots are tied completely outside the wound, avoiding the disadvantages of suture tying in a small and deep area; eliminates the dead space between anterior flaps and overlying wound tissues; keeps anterior mucosal flap complex away from posterior flaps that prevents collapse back onto the anastomosis and decreases the possibility of mucosal adhesions and, therefore, fibrotic band formation with underlying tissues that may also be useful in cases with small sacs or osseous openings and in revision cases where scarring is a large concern.
authors.affiliation: Department of Ophthalmology, Division of Oculoplastic, Orbital and Lacrimal Surgery, Erciyes University Medical Faculty, Kayseri, Turkey. evereklioglu@hotmail.com
authors.forename: Cem
authors.initials: C
authors.lastname: Evereklioglu
authors.forename: Ayşe
authors.initials: A
authors.lastname: Oner
authors.forename: Mehmet A
authors.initials: MA
authors.lastname: Somdaş
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Ketenci
authors.forename: Hakki
authors.initials: H
authors.lastname: Dogan
authors.forename: Ertugrul
authors.initials: E
authors.lastname: Mirza
authors.forename: Ozgür
authors.initials: O
authors.lastname: Ilhan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003608:Dacryocystorhinostomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000601:surgery; D009301:Nasolacrimal Duct / Q000601:surgery*; D011446:Prospective Studies; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome