First MTP joint arthrodesis produces objective improvement in propulsive power, weightbearing function of the foot, and stability during gait.

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SUMMARY Eleven consecutive patients with tumours involving the lower eyelid margin were treated with margin-including full-thickness excision of the eyelid and suturing of bleeding vessels as the sole primary surgical procedure, needing less than 10 minutes. The resulting defects of 2/5 to 7/8 of the horizontal extent of the eyelid and varying in height from 4 to 7 mm were allowed to heal spontaneously. In all the 11 patients the wounds healed, without ocular or palpebral complications in about 6 weeks and underwent further cosmetic improvement for the ensuing 6-8 weeks. Cosmetic results were excellent in 8 patients with excisions of 2/5 to i of the eyelid. All procedures including the secondary reconstructions were carried out on day-case basis under local anaesthesia. Histology confirmed complete tumour clearance in all the patients. Apart from being the first report of a planned study of spontaneous repair of full-thickness surgical wounds of the lower eyelid this study shows that the conventional method of dressing such wounds can be replaced by the less expensive and convenient 'dressing' of a cartella shield with an improvised central hole.

SUMMARY An appraisal of a personal series of 115 unselected and surgically treated cutaneous cancers of palpebral region is presented. Histological confirmation of the diagnosis and adequacy of excision was obtained for all lesions. Seven of the 8 patients with doubtful clearance were successfully treated with further surgery very soon. Complications were few, the incidence of reoperations low, and cosmetic as well as functional results were mostly satisfactory. Tumour recurred in 1 case (087%). Two patients had a poor cosmetic result. Seventy-nine cases (69%) were treated as day cases under local anaesthesia even for major repairs like full-thickness reconstruction of two-thirds of the lower eyelid and repairs with large full-thickness skin grafts of up to 20 x 55 mm by a new simple technique of graft fixation. The use of longer-acting local anaesthetics in oculoplastic surgery is described. Attention is drawn to the dangers of using direct wound closure for repair.

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