Some surgeons prefer to resect the rectus muscles, either horizontal or vertical, using one doublearm suture. This technique lacks some of the ‘insurance’ factors of using two separate horizontal mattress sutures, but, according to those surgeons who prefer this technique, it is completely safe.
The muscle is exposed and, after measurement, the extent of tendon and muscle resection is determined. A 6-0 synthetic absorbable suture is used to split the muscle at this point from edge to edge. A 3 mm loop is then taken slightly behind this suture line at each muscle border and the loops are locked. These loops should include the anterior ciliary vessels. The section of the muscle to be resected is excised with scissors after the muscle is crushed with a hemostat just behind the insertion and just in front of the suture line. Each arm of the suture is brought out through the edge of the stump of the muscle's original insertion, and the suture may be tied to itself. For more security and to prevent sag of the muscle's new insertion, each suture may be brought back through the insertion near its center. The sutures are then brought through the central portion of the muscle from beneath. The suture is gently ‘sawed’ to bring the remaining muscle up to the original insertion. A surgeon's knot is tied, securing the resected muscle in place (Figure 7).
A A single double arm suture is placed suitable for the intended resection. Locking bites are then placed immediately behind the suture.
B After cutting out the section of muscle to be resected, the sutures are brought through the stump.
C The sutures are tied.
D For added security the sutures can be brought back through the stump and muscle...
E ...and tied securely.