title: A single- versus double-layered closure technique for full-thickness lower eyelid defects: a comparative study.
abstract: OBJECTIVE
  To compare a simplified, single-layered closure technique with a double-layered closure technique in lower eyelid reconstruction following full-thickness pentagonal block excision.
  
  
  METHODS
  We conducted a retrospective, non-randomized, interventional case-control study. Clinical data of consecutive patients treated with primary closure of a full-thickness lower eyelid defect between 2011 and 2014 were analysed. In group A, the defect was closed in one layer, using non-absorbable polypropylene sutures. In group B, the defect was closed in two layers, using absorbable polyglactin acid sutures. In both techniques, we rarely used a grey line suture to adjust the eyelid margin. We assessed notching, wound dehiscence and other complications, as reported at 2 months after surgery.
  
  
  RESULTS
  We included 188 eyelids from 186 patients. In group A, we included 82 eyelids and in group B 106 eyelids. We noted no difference in notching (p = 0.96) whilst wound dehiscence had not occurred in either group. Subcutaneous granuloma formation had been noted in 0 cases in group A, versus 4 in group B (p = 0.08). Mild redness of the scar was seen in 2 cases in group A, versus 5 in group B (p = 0.41). A grey line suture was placed in 6 cases in group A (7.3%), versus 4 cases in group B (3.8%; p = 0.28).
  
  
  CONCLUSIONS
  Both single- and double-layered closure techniques are safe and effective methods for primary closure of full-thickness lower eyelid defects. In both techniques, a grey line suture was rarely required to adjust the eyelid margin.
authors.affiliation: The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
authors.forename: Jennifer S N
authors.initials: JS
authors.lastname: Verhoekx
authors.affiliation: The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
authors.forename: Renoe K
authors.initials: RK
authors.lastname: Soebhag
authors.affiliation: The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
authors.forename: Olga
authors.initials: O
authors.lastname: Weijtens
authors.affiliation: The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: van den Bosch
authors.affiliation: The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
authors.forename: Dion
authors.initials: D
authors.lastname: Paridaens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000379:methods; D016022:Case-Control Studies; D005141:Eyelid Diseases / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011126:Polypropylenes; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013536:Suture Techniques; D013537:Sutures
chemical_list: D011126:Polypropylenes
keywords: double-layered technique; full-thickness eyelid-margin defects; grey line suture; pentagonal block excision; single-layered technique