Oculoplasty Innovative Simpler Techniques Hemant Mehta Edition 2011 Publisher: Postscript Media Pvt. Ltd., Kurla, Mumbai 400 072, India No. of pages: 141 Book Review ‘Oculoplasty − Innovative Simpler Techniques’, is one of the very few publications on this subject, which is very factual, to the point and lives up to its name by being a true practical guide for all who choose to venture in this tiger territory. The author, Mr. Hemant Mehta, has in 13 neatly arranged and crisply crafted chapters poured his knowledge and experience of 32 years into true words of wisdom and he demands special appreciation for the simplicity of his thought process and lucidity of his language of expression. In his very first chapter on ‘Fundamental Techniques’ he at once soothes the tense nerves of his new readers by reassuring them that there are only five basic and fundamental procedures in Oculoplasty − excision of a lesion, skin grafts and flaps, multilayered suturing of eyelid wounds, tarso-conjunctival flaps and spontaneous repair of eyelids and the surrounding area; and in his entire book he keeps his promise and never sways from these five basic principles. The descriptions of procedures like ‘Full thickness margin inclusive (FTMI) excisions’ and ‘Tarso-conjunctival (TC) flaps’ and the accompanying photographs are clear and so refreshingly simple that one feels one is performing the procedure and seeing the anatomy unfold in front of one’s eyes. His admonition that ‘excisions should be generously liberal rather than just adequate, and never tailored to the surgeon’s capability’ is almost a clarion call to all those who flirt with occasional misadventures in this field. What is even more revealing is his choice of ‘Spontaneous repair or the Laissez Faire technique’ in fairly complex situations instead of a planned reconstruction. Lower eyelid defects up to 13 mm horizontally and 6 mm in height have been shown to undergo spontaneous repair with near normal results − comparable to, and at times superior to, surgical repairs! Minor procedures like excision of benign superficial lesions, tarsorraphy, canthotomy, canthal tendon reconstruction, management of trichiasis, entropion, epiblapharon and ectropion are all beautifully illustrated in Chapter 2, with a special mention about the techniques of administering local anaesthesia. The third chapter is devoted to the use of skin grafts, its harvest and its fixation by Yoke (quilting) sutures − a technique originated by the author in 1973. Tarso conjunctival flaps form the context of the fourth chapter and the author succeeds in demonstrating the true versatility of this flap in oculoplasty. The technique of harvesting it for reconstructing FTMI defects with a Wolfe graft is demonstrated stepwise in a very easily understandable fashion. As has been remarked elsewhere, Hemant Mehta broke new ground when he pioneered the quilting technique. Chapter 5 is devoted to the surgery of ptosis and lid retraction. The hallmark of this chapter is the segment on lid anatomy and how to select a particular operation for a particular type of ptosis. Levator resection, the frontalis sling procedure and the management of contralateral eye in ptosis have all been vividly described, with excellent photographs and a technique DVD accompanying the book. Chapters 6 and 7 on lower and upper eyelid reconstruction Access this article online Quick Response Code: Website: www.ijps.org Indian Journal of Plastic Surgery September-December 2011 Vol 44 Issue 3535 Published online: 2019-12-31 Bhattacharya: Book Review are a sheer delight to a Plastic Surgeon for the variety of reconstructive options offered for virtually every imaginable lid defect. Neat ink sketches are followed by clinical cases and each surgical procedure is written with a brief, but clear, description of the methodology. The author boldly dedicates two chapters to ‘Spontaneous repair’ and goes on to explain the logic of healing by secondary intention in most difficult situations like the medial canthus, with stunning results, aided, only at times, by a second stage ectropion correction. The author candidly admits ‘it is difficult to explain the amazing and uncanny ability of the eyelids to reform their shape and substance − skin lamina, conjunctival layer, fornix, canthal tendons,’ and then goes on to postulate that the phenomenon of ‘tropism’ as seen in the plants may be responsible for this amazing repair process. He is, however, not afraid to admit that his explanation is feeble, hypothetical and perhaps inappropriate, but he has no doubt opened a new area of research in regenerative sciences! In Chapter 9 the author presents his understanding of eyelid injuries and offers suggestions for extra-marginal lacerations, full thickness eyelid lacerations and special injuries like canalicular tear, canthal tendon injury and levator muscle and aponeurosis injury. With a good surgical technique the author feels that we can avoid ugly scars, infection, loss of skin fold, ptosis, dermatochalasis, suture irritation of the conjunctiva, epiphora, marginal notching and offsetting, entropion, ectropion and symblepharon. Orbital Surgery including management of blow-out fractures, enucleation, evisceration and exentratioin have all been briefly described in a separate chapter in order to make the subject of Oculoplasty complete. The author, however, saves the best for last when he, most unexpectedly, dedicates a full chapter to Clinical Photography and describes in detail photographic equipment − cameras, macro lenses, flashguns, digital photography, its file types and its image editing software. His mastery on this subject is obvious, because every claim that he makes in this book is substantiated by superb photographic evidence. His theory of spontaneous repair is a perfect example and had it not been for his excellent follow-up photographic records, no one would believe his claim. The author ends his book with a chapter on ‘Innovations’, which he feels are creative ideas that offer alternative solutions that may replace the prevailing established practices. He is of the view that an assumption that has the acceptance of general consensus does not guarantee correctness and being rigid about them stifles originality. In his inimitable story-telling style he goes on to describe the circumstances surrounding his various innovations. The book ends aptly with a homage to Sushruta, the father of surgery, for being an innovator par excellence! A hard bound book of 140 plus pages is accompanied by a meticulously recorded and beautifully presented technique DVD on ptosis surgery. The book has been published by Postscript Media Pvt. Ltd and because of its clarity of contents and more than 700 photographs of the highest quality, it is sure to receive international acclaim and citation. Foreworded by Mr. M. J. Roper-Hall, the editor of Stallard’s Eye Surgery sixth and seventh editions; Mr. Mehta very aptly dedicates this masterpiece to Sushruta. Surajit Bhattacharya Editor, Indian Journal of Plastic Surgery E-mail: surajitbh@yahoo.co.in Indian Journal of Plastic Surgery September-December 2011 Vol 44 Issue 3 536