Tension and Distortion of the Upper Double Eyelid by a Nonincision Method

The aim of this study was to compare the suture tension and the extent of distortion according to the continuous and interrupted suture methods. An in vitro eyelid model of 10-cm length and 5 layers was made with a 3-layer skin pad for the skin, muscle, and aponeurosis and silicone sheet and sponge for the tarsal plate and conjunctiva. The thickness of the model was 11.8 mm. All interrupted sutures were used in Khoo's method, the buried method, and Mikamo's method, and a continuous suture was applied in the 2-loop en bloc method, the subconjunctival buried method, and Maruo's method. The thickness of the eyelid was measured with a custom-made micrometer that had tacks attached on a measuring bar. The tension was measured with a force-gauge. The distortion in the interrupted suture methods was 15.2% ± 3.4% of the original thickness, and it was significantly greater than the 3.3% ± 2.8% of the original thickness in the continuous suture methods (P = 0.000, t- test). In the interrupted suture methods, Khoo's method showed the greatest rate of distortion (16.9% ± 4.5%), and this was followed by Mikamo's technique (14.5% ± 2.5%) and the buried suture method (13.6% ± 1.4%). For the continuous suture methods, the 2-loop en bloc method showed the least tension (0.33 ± 0.05 N), and this was followed by Maruo's method (0.41 ± 0.07 N) and the subconjunctival buried suture method (0.45 ± 0.07 N). The tension of the suture at each loop was significantly greater (P = 0.000, t-test) in the interrupted suture methods (0.52 ± 0.07 N) than that in the continuous suture methods (0.41 ± 0.08 N). For the interrupted suture methods, Khoo's methods showed the greatest rate of tension (0.54 ± 0.06 N) compared with the buried suture technique (0.51 ± 0.08 N) and Mikamo's technique (0.48 ± 0.07 N). For the continuous suture methods, the 2-loop en bloc method showed the least tension (0.33 ± 0.05 N), followed by Maruo's method (0.41 ± 0.07 N) and the subconjunctival buried suture method (0.45 ± 0.07 N). We contend that a continuous suture method causes minimum notching, whereas an interrupted suture method causes less incidence of double-fold fading.