2.  How do you repair a full thickness laceration of an eyelid margin?  Review the layers of the eyelid.  Which layers do you suture?  What suture do you use?  When do you remove them?

Answer:
There are 3 layers or lamellae:  skin/orbicularis (external lamella), tarsus (middle lamella), and conjuctiva (internal lamella).  Lacerations involving the eyelid margin require precise reapproximation to prevent notching or irregularities.  The wound edges are minimally debrided.  The first suture (6-0 silk) is placed at the lid margin including the edge of the tarsus.  Traction on this suture aligns the wound edges.  The pretarsal orbicularis muscle is reapproximated with absorbable suture and the skin is reapproximated with 6-0 Nylon.  Sutures are removed in 3-4 days.

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