Text-book of ophthalmology . ecure the connection between the lidand the frontalis muscle by the formation of a pedicle from the skin of theformer, which pedicle is attached tothe skin of the forehead and to thesurface of the muscle. Fig. 441 showshow the pedicle is cut out of the skinof the lid. The pedicle, s, after beingdefined by incision, is dissected fromits bed until it is freely movable; thena horizontal incision, a, is madethrough the skin directly above theeyebrow. Starting both from this in-cision and from the wound alreadymade below, the skin of the eyebrowis undermined so that a b
Text-book of ophthalmology . ecure the connection between the lidand the frontalis muscle by the formation of a pedicle from the skin of theformer, which pedicle is attached tothe skin of the forehead and to thesurface of the muscle. Fig. 441 showshow the pedicle is cut out of the skinof the lid. The pedicle, s, after beingdefined by incision, is dissected fromits bed until it is freely movable; thena horizontal incision, a, is madethrough the skin directly above theeyebrow. Starting both from this in-cision and from the wound alreadymade below, the skin of the eyebrowis undermined so that a bridge of tissueis formed, beneath which the pedicle,s, is slipped so that its upper in contact with the upper lip of theincision, a. Its attachment to the latter is effected by means of a loop ofthread, the center of which lies on the cutaneous side of the pedicle, whileits extremities, b b, are passed through the upper lip of the wound. Bydrawing the loop tight the pedicle is lifted up and is attached to the upper. Fig. 441.—Panass Operation for Ptosis, 966 TEXT-BOOK OF OPHTHALMOLOGY border of the wound. If necessary, a second loop may be applied, and alsosome interrupted sutures, to secure exact adaptation of the edges. [In theTansley-Hunt modification of this operation the incision is so made thatthe base of the pedicle is close to the free border of the lid. On either sideof the lower half of the pedicle, an elongated triangle of skin is exsected,each triangle having its base directed toward the pedicle. In order to securebetter union, the epithelial surface of the pedicle is scraped before the latteris drawn up into the hole under the eyebrow (Wheeler).—D.] The operation produces a satisfactory effect but has the disadvantageof leaving scars which run perpendicular to the direction of the fibers of and hence are pretty conspicuous. 845. 3. The superior rectus is also available for replacing the levator[provided the former itself is not defecti
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