title: Combined posterior flap and anterior suspended flap dacryocystorhinostomy: A modification of external dacryocystorhinostomy.
abstract: BACKGROUND
  External dacryocystorhinostomy (DCR) remains a reliable surgical technique for the treatment of obstruction of lacrimal drainage system beyond the common canalicular opening.
  
  
  OBJECTIVE
  To describe a simple modified double flap external DCR technique.
  
  
  METHODS
  Ninety six consecutive cases of chronic dacryocystitis with or without mucocele were selected irrespective of age and sex. In a modification to routine external DCR, a modified technique was followed, where both anterior and posterior flaps of lacrimal sac and nasal mucosa are created and sutured. Two double armed sutures were used to join the edges of anterior flaps, and elevate them anteriorly to avoid adhesion or apposition with underlying sutured posterior flaps, and to approximate the deep plane of the wound.
  
  
  RESULTS
  At the end of average follow-up period of 13 months, we observed 98.9% objective and 96.8% subjective success rates. The average operation time was 45 minutes. No significant intraoperative or postoperative complications were noticed.
  
  
  CONCLUSIONS
  We believe that combined posterior flap and anterior suspended flap DCR technique is simple to perform and has the advantage of both double flap DCR and anterior suspension of anterior flaps. The results of the study showed the efficacy of this simple modification.
authors.affiliation: Bawri Nethralaya, Shillong, Guwahati, India.
authors.forename: Amarendra
authors.initials: A
authors.lastname: Deka
authors.forename: S P
authors.initials: SP
authors.lastname: Saikia
authors.forename: S K
authors.initials: SK
authors.lastname: Bhuyan