Full-thickness wedge biopsy
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This is Richard Allen at the University of Iowa.
This video demonstrates a full thickness biopsy of the lower eyelid.
The patient has a suspicious lid lesion, previous biopsy of which was uninformative. Therefore, a full-thickness wedge biopsy will be performed. A pentagonal design has been marked. The 15 blade is used to make vertical incisions through the eyelid margin. The blade is then used to make an incision through the skin and orbicularis to complete the pentagon. The biopsy is then completed with an incision with the blade inferior to the inferior border of the tarsus. The blade is used to give clean, sharp edges. The specimen is sent to the pathologist.
Direct closure should be able to be performed. A 5-0 Vicryl suture is placed partial thickness through the anterior surface of the tarsus on each side of the defect. This suture is left untied. An additional suture is placed in the same manner. Usually two sutures are plenty. These sutures are then tied. The lid margin is then re-apposed with 7-0 Vicryl suture which is placed in a vertical mattress fashion. One suture is placed at the level of the Meibomian gland orifices. An additional suture is placed at the level of the lash follicles. This results in eversion of the lid margin. The skin can then be closed with interrupted 7-0 Vicryl sutures.