Surgical pearl: temporary suspension suture (Frost suture) to help prevent ectropion after infraorbital reconstruction

Abstract

An ectropion is a complication that can arise from reconstruction in the infraorbital region (Fig 1). Often, this complication occurs despite proper positioning of the lower lid at the time of closure. Edema and bleeding postoperatively can cause the lower lid to pull away from the globe. Fibrosis and subsequent contracture in this position can lead to an ectropion. To help prevent this we have incorporated the use of a temporary suspension suture, known in oculoplastics as a Frost suture, 1 for selected closures in the infraorbital area. After an appropriate closure has been executed (Fig 2), a 4-0 nylon suture is passed through the tarsus or just inferior to it. Both ends of the suture are then attached to the skin above the eyebrow (Fig 3). This serves as a sling as the tension of the suture is directed in a manner that most closely approximates the normal anatomic location of the lower lid. The suture may be attached either by sewing it to the skin or by use of adhesive strips. When passing the suture through the lower lid margin, the surgeon should avoid placing the lower end of the suture through the puncta or canaliculus. Likewise, the surgeon should be aware of the supratrochlear or supraorbital neurovascular bundle if sewing the upper end of the suture. Adhesive strips may be preferable because they allow the tension to be easily adjusted, if necessary, in the postoperative period. One should use large strips and a liquid adhesive when attaching the suture by this method. The suture remains in place for approximately 3 days, depending on the clinical appearance and the amount