BACKGROUND Patients with lid surgery may benefit from traction sutures. However no detailed descriptions of the techniques exists. We describe our techniques and experiences in patients with cicatricial ectropion and large lid defects. METHODS In 33 patients with severe cicatricial ectropion, the wound was extended with transtarsal traction sutures before skin grafts or sliding flaps were sutured in place. Horizontal traction sutures allowed wound closure in 7 patients with tumors of the medial canthal area or large traumatic lid defects. In all patients monofil 4-0 polypropylene suture material was used. RESULTS Vertical transtarsal traction sutures and horizontal traction sutures did not cause any irritations of the lids or wound edges. Postoperative overcorrection of the lower lid margin was achieved in all ectropion patients. However, five patients required additional surgery. Three patients were operated for bilateral cicatricial ectropion simultaneously. Postoperative shrinkage of the free skin-graft was more accelerated on the side where the transtarsal traction sutures were first removed. Horizontal traction sutures allowed wound closure in all seven patients who had undergone medial canthal reconstruction and traumatic lid repair. CONCLUSIONS Traction sutures with monofil 4-0 polypropylene material can fixate the lid margins and wound edges in the preoperatively desired position. There is evidence that the traction sutures can influence postoperative wound contraction. Our technique of transtarsal traction sutures has several advantages as compared with previously described techniques.