Repair of full-thickness upper eyelid laceration
This is Richard Allen at the University of Iowa. This video demonstrates repair of a full-thickness upper eyelid laceration.
A 5-0 Vicryl suture is placed partial thickness through the anterior surface of the tarsus.
It is very important to make sure that this suture is not place through the posterior surface of the tarsus in upper lid repairs as this will result in irritation post-operatively.
The suture is placed similarly on the other side of the laceration.
An additional suture is placed inferiorly. Again, making sure it is not placed full-thickness. The suture is tied.
I like to place this sutures first to take tension off of the eyelid margin repair.
The eyelid margin is then repaired with 7-0 Vicryl suture which is placed in a vertical mattress fashion.
This suture is placed at the meibomian gland orifices. It is placed in a far – far, then near – near fashion.
The suture is placed at the same depth and distance from the lid margin on each side of the laceration.
The importance of placing this vertical mattress suture is to evert the lid margin once it is tied.
An additional suture will then be placed at the lash follicles, also placed in a vertical mattress fashion.
I prefer an absorbable suture in this repair. The 7-0 Vicryl rarely causes any post-operative irritation and it does not need to be removed.
The anterior lamella is then repaired by placing an additional 7-0 Vicryl suture superior to the lashes in a vertical mattress fashion. This supports further eversion of the lid margin.
The remainder of the repair can be performed with simple interrupted sutures through the skin.
Antibiotic ointment is placed over the repair, and the patient is seen in one week for reevaluation.