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The aim of this study was to compare the effect of W-shaped skin (WS) and linear skin (LS) incisions on cutaneous scar tissue formation in patients who have undergone bilateral external dacryocystorhinostomy.
Sixteen patients (14 females and two males) with acquired bilateral nasolacrimal duct obstruction were included in this prospective, interven...
Citations
... 34 The mean age in our study was 67.94 +/-16.07 years which was almost the same as the study done by Sharma et al. 31 (67y) higher than Devoto et al. 9 (61 years), much higher than the studies done Kashkouli et al. 35 (52.9y) Ekinci et al. 36 (40.8 ± 14.3 years). ...
Purpose: Dacryocystorhinostomy surgery may result in significant postoperative scarring. Although other surgical techniques have been developed that achieve a better aesthetic result, the ab externo technique remains the gold standard for this procedure. We developed a telephone survey to evaluate the visual impact of postoperative skin scars associated with ab externo dacryocystorhinostomy.
Methods: 470 patients underwent uncomplicated external dacryocystorhinostomy surgery by two consultant surgeons from January 2014 to December 2021. Skin incisions were closed using intradermic continuous suture with prolene 6.0. The exclusion criteria were cases of dacryo-phlegmon and lacrimal sac fistulae with skin maceration. The visual effect of the postoperative scar was evaluated, and the degree of patient satisfaction was measured by a questionnaire with four subjective perceptions of the scar (very good, good, bad, very bad) given by a physician in the first postoperative month. The survey responses were used as the basis for a literature review.
Results: The survey received 470 responses (100%) Very good perception of the scar was achieved in 75,8% of patients. There were no other post-operative complications noted from medical records review.
Conclusions: Given the small percentage of patients who complained of marked scarring, it should not be the main reason for deciding on the procedure for dacryocystorhinostomy, especially in elderly patients.
Therefore, the surgical technique should be considered as a surgically acceptable choice if cosmetic results were selection criteria in the case of total stenosis of the nasolacrimal duct.
... In our case, this was modified to a horizontal zig-zag incision and closed with resorbable sutures to allow a more pleasing cosmetic result, as compared to that of the traditional straight incision. This type of incision [14,15], as well as the use of resorbable sutures [16], is recommended for a more pleasing scar in transcollumellar incisions and dacryocystorhinostomy. Although many advocate a limited local incision in children [6,17], the approach to a glabellar cyst can be achieved through an anterior hairline incision at the superior forehead [2]. ...
A dermoid cyst of the nose is a relatively rare anomaly seen normally in the first few years of life. They are distinct to dermoid cysts located elsewhere in the body as there is a potential for extension to intracranial structures. Presentation in adulthood is rare and often because of a missed diagnosis in childhood. We present the case of an adult man with a superficial nasal dermoid cyst presenting over the nasion. The operation was performed by direct excision at the nasion with a novel modified horizontal zig-zag skin incision, instead of the traditional vertical excision, with a good cosmetic result. The cyst was radically excised and there was no evidence of extension intracranially. The case is discussed in relation to the current surgical literature in both children and adults.
... 11 Various modifications are being studied extensively to reduce scarring and improve the cosmetic appearance postoperatively. [12][13][14] Meticulous surgical technique is the key factor in this aspect. Few simple measures described are the proper use of local anesthesia, incision, location, maintain a minimal bleeding surgery, using a skin flap technique, and simple orbicularis and skin wound closure. ...
... Dave et al. 12 also found an excellent functional cosmetic scar outcome with subciliary incision while retaining the access and advantages of ext-DCR procedure. The lower eyelid crease incision approach is also an excellent approach for ext-DCR, which leaves an unapparent scar as reported by Akaishi et al. 18 and Mjarkesh et al. 19 Ekinci et al. 13 also conducted a study in patients who have undergone bilateral external dacryocystorhinostomy to compare the effect of W-shaped skin and linear skin incisions on cutaneous scar tissue formation with linear skin incision applied to one side and W-shaped skin incision to the other side. W-shaped skin incision were found to have less cutaneous scar tissue formation compared with linear skin incision on the other side of the nose in patients who have undergone bilateral external DCR. ...
... E xternal dacryocystorhinostomy (DCR) is widely recognized as an effective procedure to treat tearing resulting from nasolacrimal duct obstruction (NLDO). 1,2 The obstruction can affect 1 or both nasolacrimal duct(s) and the DCR surgery can be performed unilaterally or bilaterally. 3 When the surgery is bilateral the procedure can be done in the same day, treating both lacrimal systems in a single session or on different days (asynchronous). ...
Purpose:
To evaluate the characteristics of bilateral nasolacrimal duct obstruction (NLDO) carriers and success rates of same day (simultaneous) or asynchronous (different day) bilateral dacryocystorhinostomy (DCR).
Methods:
This retrospective study included patients with bilateral NLDO who underwent bilateral external DCR between January 2010 to August 2015 at the King Khaled Eye Specialist Hospital, Saudi Arabia. Postoperative success rate was considered as subjective perception of no tearing bilaterally or failure if unilateral or bilateral tearing persists after surgery. Data were statistically analyzed with P <0.05 indicating significance.
Results:
Of 57 patients undergoing bilateral DCR, 32 (56%) had same-day surgeries and 25 underwent asynchronous surgery. The median duration of follow up was 7 months. The success rates were similar for the same day group [61.3%-95% CI 49.4-73.2)] and for the asynchronous group [54.2% (95% CI 40.4-68.0)]. Success rate was not correlated to the age, gender, or use of stents.
Conclusions:
The authors strongly recommend bilateral same-day external DCR to treat bilateral NLDO since the success rate of the procedure is similar to the asynchronous surgery, allowing a full treatment in just 1 operative visit.
... A recent study suggests that, in addition to the above-mentioned factors, the shape of the incision also has a significant impact on scar visibility. 9 Many types of surgical incisions like curvilinear tear trough, 10,11 sub-ciliary lower eyelid, [12][13][14] W-shaped nasal, 9,15 and trans-conjunctival subcarancular 16,17 have evolved in an attempt to reduce the scar visibility. A recent study com-pared linear and W-shaped incision (WSI) and found that WSI is cosmetically better. ...
... A recent study com-pared linear and W-shaped incision (WSI) and found that WSI is cosmetically better. 9,15 In this study authors commented that it would have been more clinically meaningful to compare CLI instead of a linear incision. They mention this fact as a ''major limitation'' of their study. ...
... They mention this fact as a ''major limitation'' of their study. 15 There is only one study comparing WSI and CLI in ExDCR till date. 18 Hence we undertook this study to analyze the skin scarring objectively after WSI and CLI. ...
Purpose:
The major drawback of an external dacryocystorhinostomy (ExDCR) is visible skin scar leading to poor patient satisfaction. In this study we have analyzed the skin scarring objectively after Curvilinear incision (CLI) and W shaped incision (WSI).
Methods:
This is prospective trial done at Department of Ophthalmology at tertiary level hospital. All the patients with primary acquired nasolacrimal duct obstruction were included in the study. Patients were assigned to group A(CLI) or Group B (WSI). Cosmetic outcome was assessed by scar visibility at 1st, 3rd and 6th month postoperatively by two ophthalmologists separately, who were unaware of incision type.
Results:
We studied 64 patients with median age 59.0 years (IQR [Interquartile range]: 50.0-66.8 years). Scar visibility was significantly (p = 0.001) more in WSI group at all follow-ups. None of the patients of CLI group showed visible scar at six months whereas ten patients (31.3%) of WSI group still had minimal scar (p < 0.001). Older patients had significantly less scar than younger patients. The time taken to perform ExDCR was significantly more with WSI (41.0 min, IQR: 40.0-44.0 min) than for CLI (33.0 min., IQR: 31.3-35.0 min); p < 0.05. Overall complication rates were similar in both the groups (p > 0.05) but extension of skin incision was more common in WSI group.
Conclusions:
We found that CLI is more aesthetic, simpler, requiring less operative time and less incision related complications when compared with WSI.
... 11 Various modifications are being studied extensively to reduce scarring and improve the cosmetic appearance postoperatively. [12][13][14] Meticulous surgical technique is the key factor in this aspect. Few simple measures described are the proper use of local anesthesia, incision, location, maintain a minimal bleeding surgery, using a skin flap technique, and simple orbicularis and skin wound closure. ...
... Dave et al. 12 also found an excellent functional cosmetic scar outcome with subciliary incision while retaining the access and advantages of ext-DCR procedure. The lower eyelid crease incision approach is also an excellent approach for ext-DCR, which leaves an unapparent scar as reported by Akaishi et al. 18 and Mjarkesh et al. 19 Ekinci et al. 13 also conducted a study in patients who have undergone bilateral external dacryocystorhinostomy to compare the effect of W-shaped skin and linear skin incisions on cutaneous scar tissue formation with linear skin incision applied to one side and W-shaped skin incision to the other side. W-shaped skin incision were found to have less cutaneous scar tissue formation compared with linear skin incision on the other side of the nose in patients who have undergone bilateral external DCR. ...
Purpose:
To compare the cosmetic outcome of the surgical scar of external dacryocystorhinostomy by the subcuticular versus sutureless technique.
Methods:
This was a prospective interventional randomized control study conducted at tertiary level hospital. Fifty patients of primary-acquired nasolacrimal duct obstruction were included in this study. The control group patients underwent the technique of wound closure in 2 layers, subcutaneous interrupted suture with 6-0 vicryl and superficial skin with 6-0 prolene continuous subcuticular sutures. In the case group, interrupted subcutaneous sutures with 6-0 vicryl with Steristrip for skin apposition was used. The surgical scars were assessed and graded by still photographs on a computer screen by 2 independent observers unaware of the surgical technique used at 2, 6 and 12 weeks postoperatively.
Results:
The mean scar assessment score by the 2 observers were 2.60 (0.57), 2.04 (0.64), and 1.16 (0.89) in control group and 2.02 (0.65), 1.44 (0.70), and 0.44 (0.61) in case group at 2, 6, and 12 weeks, respectively. Scar grades were analyzed using chi-square test between the 2 group and Wilcoxon signed rank test within the group. The difference between the 2 groups were found to be statistically significant at 2, 6, and 12 weeks (P < 0.05). Thus, the technique of wound closure with steristrip lead to comparatively less scarring as compared with subcuticular technique.
Conclusion:
The authors recommend the sutureless technique of wound closure using steristrip in Ext DCR as it has superior cosmetic results as compared with subcuticular technique of external dacryocystorhinostomy.
... Correction of blowout fractures of orbital wall [332], dacrocystorhinostomy [333], Genioplasty [334], Septoplasty [335], decompression operation for the brain [336], cataract surgery [337], Forehead lift [338], cleft lip open rhinoplasty [339], Glanduloplasty [340], surgical repair of buried penis [341], 24. X shaped Incision [n -194] Auricle, trachea, perineum, umbilicus, hymen, posterior longitudinal ligament, Intervertebral disc, blind vaginal pouch [342], nasal fat pad, transatrial septum ...
Incisions are the primary step of almost all invasive procedures, as each and every surgery gets initiated by certain specific shaped
incision on a specific site for rectifying the underlying pathology. Apart from the detailed narration mentioned in Ancient Ayurvedic
surgical texts, no other concrete historical contribution is available. Surgical science has evolved enormously over the years and numerous
surgical procedures have been added with the prime focus of aiding the ill. With this stupendous growth, several incisions are
also being invented analogous to various shapes of letter, object, animal, and fruit. This review details on the incisions evolved based
on the shape of specific English Alphabet.
... 材料的研究增多,且泪道置管术本身手术操作简单、成功 率高,故应用广泛。 植入管类型种类较多,如类" Y冶 形硅 胶管、双泪小管植入式硅胶人工泪管、鼻泪管支架等。 泪 道置管手术不改变泪道解剖结构,并使得泪道生理通道 恢复,保证了泪液的引流通畅。 但在泪道置管术后,有文 献表明,在泪道置管术拔管后,鼻泪管再阻塞发生率高达 9. 81% ~ 31. 78% [3] [20] ,手术 费用低且简单易行。 但缺点主要为皮肤瘢痕及手术改变 原有解剖结构引起泪液泵功能异常。 近年一些术者对皮 肤切口大小、位置等进行改进,采用 W 型切口 [21] 、内眦部 小切口 [22] 等方式,术后瘢痕明显减小。 故有学者认为由 于外路手术的诸多优点,对于泪囊憩室、泪囊及鼻泪管附 近骨性结构异常、可疑泪囊结石或新生物、严重面部外 伤、结节病或 Wegner 肉芽肿等病例,首选外路手术 [23] 。 2. 2 内镜下泪囊鼻腔吻合术摇 近年来,随着鼻内镜技术 及材料的飞速发展及其在鼻部疾病手术中运用的日渐成 熟,经鼻的泪囊鼻腔吻合术越来越多,其可以避免皮肤切 口瘢痕且可以同时处理鼻部病变,故对于合并鼻部病变、 泪囊炎急性发作及外路手术术后复发患者更有优势 [23] , 其手术成功率为 60% ~ 90% [20] 。 有学者 [24] 对外路泪囊 鼻腔吻合术及内镜下泪囊鼻腔吻合术术后长期效果进行 研究发现,前者成功率为 90. 2% ,后者为 89. ...
Nasolacrimal duct obstruction is a common disease, which have a high morbidity. The treatment of this disease is to take surgeries. In recent years, with new materials and various kinds of endoscopic technique gradually maturing, the treatment for nasolacrimal duct obstruction have had great advance. But after the operation, there are some people whose nasolacrimal duct obstruction happen again. The research on the mechanism of recurrence of nasolacrimal duct obstruction also increased nowadays.In this paper, the surgical treatment and the mechanism of the recurrence of nasolacrimal duct obstruction were reviewed.
... Curvilinear incision avoids scar formation as much as possible and follows the relaxed skin tension lines better and with less webbing in E-DCR [19]. Also W incision may be considered as a modified form of Z-plasty and Ekinci et al. showed that W incision is effective in reducing incisional scarring by relaxing skin tension in patients undergoing E-DCR [20]. In our study mean assessment scores for both curvilinear and W incisions were similar in two groups. ...
Purpose:
To compare the outcomes of external dacryocystorhinostomy (E-DCR) by using two different flap anastomosis patterns and skin incision types.
Methods:
This study included 79 patients (88 eyes) with lacrimal drainage system disorders who underwent E-DCR surgery. Fifty eyes of 44 patients (group A) underwent E-DCR by suturing anterior and posterior flaps (H-flap) of the lacrimal sac with curvilinear skin incision whereas in 38 eyes of 35 patients (group B) DCR was performed by suturing only anterior flaps (U-flap) with W skin incision.
Results:
The success rate was evaluated according to lacrimal patency and scar assessment scores. Patency was achieved in 78 patients (88.6%). In terms of groups, patency was 44 eyes (88.0%) in group A and 34 eyes (89.5%) in group B. There was no statistically significant difference in the success rates of lacrimal patency between the two groups. Further, there was no statistically significant difference concerning cutaneous scar scores.
Conclusion:
Our study suggests that anastomoses of only anterior flaps or both anterior and posterior flaps have similar success rates; suturing only anterior flaps is easier to perform and shortens the operative time. In addition, W skin incision is a reasonable alternative to curvilinear incision for reducing scar formation.
This technical report aims to provide a visual guide to the drill-assisted external dacryocystorhinostomy (DCR) technique with silicone intubation. Through a step-by-step video demonstration, it addresses inherent documentation challenges and highlights crucial considerations. A critical aspect of the procedure's success lies in creating a clear space around the drilling area to prevent thermal burns and soft tissue wrapping around the burr. Additionally, it emphasizes the careful use of smaller burr diameters and the importance of drilling techniques, advocating for minimal perpendicular drilling while maintaining rotational polishing movements to minimize the risk of rapid penetration and potential nasal mucosal injury.
The thermal cauterization of perforating nutrient vessels during bone drilling offers a significant advantage in reducing the risk of bleeding. A review of existing limited studies comparing drill-assisted and conventional external DCR reveals advantages such as shorter surgical duration, lower intraoperative hemorrhage rate, more regular osteotomy edges, increased ostomy patency, and potential prevention of soft tissue or mucosal injuries. Nonetheless, achieving these benefits necessitates enhanced hand and foot coordination. However, despite these benefits, a noticeable gap exists in the literature concerning comprehensive studies and comparative analyses. Furthermore, exploring the associated cost and learning curve of adopting this surgical technique is essential.
This report aims to fill the existing gap in the literature and serve as a visual reference for surgeons interested in adopting drill-assisted external DCR.
