Eyelid reconstruction in seven dogs using a split eyelid flap

Eyelid reconstruction and infraorbital repair using a Mustardé flap technique in a dog

This case report describes a 5-year-old dog with a defect in the right eyelid, absence of orbicularis musculature, and absence of cutaneous tissue in the infraorbital region, submitted to the Mustardé flap technique. A large rotational flap was performed, including a cartilage graft from the outer ear, to correct the defect in the lower eyelid and infraorbital region. Also, euryblepharon correction of the upper eyelid was performed with wedge excision. The techniques were performed in a single surgical step and with appropriated functional and aesthetic results. The described approach may be employed as a surgical option in large eyelid defects.

Caudal Auricular Axial Pattern Flap for the Reconstruction of the Upper Eyelid in Three Cats

Three cats bearing malignant tumors (two squamous cell carcinomas and one peripheral nerve sheath tumor) affecting the upper eyelid (UE) were treated by en bloc tumor removal. A caudal auricular axial pattern flap was used for reconstruction, and its margin was sutured to only the medial and lateral canthus in two cats; in the third cat, a narrow strip of spared conjunctiva was sutured to the flap margin. Postoperatively, superficial corneal ulcers occurred in two cats, but they healed with topical treatment. Apart from a reduced ability to blink, no further functional deficits persisted, and the long-term cosmetic appearance was considered satisfactory by the owners. Tumor-free excisional margins were achieved in two cases. Tumor recurrence in the long-term was observed for two cats, 350 and 380 days after surgery, one of whom had excisional noninfiltrated margins on histologic examination. UE reconstruction to preserve eyelid function following tumor excision without exenteration is challenging. In selected cases, caudal auricular axial pattern flap is one of the surgical options available to reconstruct the defect resulting from en bloc UE removal without any replacement of the mucosal layer.

Outcome of secondary intention healing of full thickness lower eyelid defects in dogs

OBJECTIVES

To assess healing of the canine lower eyelid without anatomical reconstruction.

MATERIALS AND METHODS

Retrospective case series of three client-owned dogs with lower eyelid defects. These dogs that underwent debridement of lower eyelid wounds that were left to heal by secondary intention were assessed for anatomical, functional and aesthetic outcomes.

RESULTS

Two of the cases had previously undergone tumour resection with a lip-to-lid reconstruction and, following flap failure, developed a full thickness defect. The third dog presented with a traumatic laceration. Each dog lost approximately 70 to 90% of the lower eyelid margin. Two received topical antimicrobial eye drops after debridement, while the third dog required no further treatment. Follow-up periods of 3 years, 15 months and 4 months were available. All owners were satisfied with the cosmetic outcome and provided pictures. One owner reported epiphora but no other ophthalmic complications occurred.

CLINICAL SIGNIFICANCE

The result of this small case series supports the notion that not all lower eyelid injuries or tumour resections require anatomical reconstruction. Selected cases can be left to heal by secondary intention with minimal post-operative complications.

Retrospective evaluation of canine palpebral masses treated with debulking and cryotherapy: 46 cases

PURPOSE

To evaluate the recurrence frequency and the time to recurrence of canine palpebral masses treated with debulking and cryotherapy.

METHODS

Medical records of dogs that underwent debulking and cryotherapy for palpebral masses from December 2010 to November 2015 at the University of Minnesota's Veterinary Medical Center were reviewed. A telephone survey with owners was used to determine recurrence and time to recurrence.

RESULTS

Forty-six masses (31 dogs) were included in this retrospective study. Included palpebral masses were as follows: adenomas 17/46 (37%), epitheliomas 8/46 (17.4%), papillomas 6/46 (13%), inflammatory masses 6/46 (13%), mixed adenoma-papillomas 6/46 (13%), mixed epithelioma-papillomas 2/46 (4.4%), and a melanocytoma 1/46 (2.2%). Of the seven masses that were noted to recur (7/46, 15.2%), three were mixed adenoma-papillomas (three of six adenoma-papillomas, 50%), two were epitheliomas (two of eight epitheliomas, 25%), one was a papilloma (one of six papillomas, 16.7%), and one was a melanocytoma (one of one melanocytoma, 100%). Average recurrence time was 367.9 days [range: 30-904 days]. A significant association between tumor type and tumor recurrence was found (P = .009). Adenomas were significantly less likely to recur (P = .017), and mixed adenoma-papillomas were significantly more likely to recur (P = .001).

CONCLUSIONS

Debulking and cryotherapy is an effective method of treatment for eyelid masses in dogs with a low study recurrence rate of 15.2% and average recurrence time of 367.9 days. Results also suggest that mixed adenoma-papilloma masses have a significantly higher recurrence rate than other eyelid masses, whereas adenomas had no recurrence in our study population.

Use of an axial pattern flap and nictitans to reconstruct medial eyelids and canthus in a dog

A 10-year-old male neutered Boxer presented with recurrence of a mast cell tumor at the right medial canthal area. Following excision including 2 cm margins, the medial one-half of the upper and lower eyelids and the medial canthus were reconstructed using an axial pattern flap based on the cutaneous branch of the superficial temporal artery. The bulbar conjunctiva of the nictitans was preserved and sutured to the medial flap edge, thus creating a conjunctival lining to the deep aspect of the flap, protecting corneal epithelium. This is a valuable surgical technique for closing a large skin defect and reconstructing the medial eyelids, thus preserving the globe.

Management of eyelid neoplasms in the dog and cat

Eyelid neoplasms are common in the older dog and typically benign. Eyelid neoplasms in the cat are less common and more often malignant. Resection of eyelid masses may be curative; however, restoration of the eyelid structure after mass excision is essential for maintaining long-term ocular surface health. Surgical techniques and instrumentation for eyelid surgery are reviewed. Indications, benefits. and limitations of sharp excision, cryotherapy, and laser excision and ablation are discussed. Neoplasia of the third eyelid is also discussed.

Use of the Lip-to-Lid Flap for Replacement of the Lower Eyelid in Five Cats

OBJECTIVE

To report outcomes after reconstruction of the lower eyelid following resection of squamous cell carcinoma (SCC).

STUDY DESIGN

Retrospective study.

ANIMALS

Five cats (6 eyelids).

METHODS

Case records were reviewed for breed, sex, surgical findings, complications, and outcome.

RESULTS

Six eyelids were reconstructed in 5 cats; functional outcome was excellent. Neither wound breakdown nor flap failure occurred. An area of superficial necrosis occurred in 1 cat; this spared the eyelid margin and healed by secondary intention without any cosmetic or functional effect. One cat was euthanatized 18 months later because of a nasal mass. The relationship between the nasal mass and the previously excised SCC was not established.

CONCLUSIONS

Reconstruction of the lower eyelid using a lip-to-lid flap yields satisfactory functional and cosmetic results in cats.

CLINICAL RELEVANCE

A lip to lid flap is a successful form of single-stage reconstruction after lower eyelid excision in cats.

Eyelid reconstruction using a split eyelid flap after excision of a palpebral tumour in a Persian cat

This case report documents the use in a cat of a method of palpebral reconstruction previously only described in a series of dogs. A split eyelid flap was used to reconstruct a deficit created by the removal of an apocrine adenoma of the paratrichial sweat gland on the upper lid. This particular technique was chosen over other methods because of its ability to create a smooth hairless eyelid margin. The method previously described in dogs was modified in the present case to address both the fact that the resection was more extensive and the difference in periocular anatomy in the cat.

Adnexal surgery in dogs and cats

Abnormalities in eyelid position and function can lead to chronic irritation of cornea and conjunctiva. Corneal ulceration, vascularization and pigmentation are common consequences. Loss of vision, or loss of the globe may be the end result. The combination of ptosis and entropion of the upper eyelid is commonly seen in breeds with abundant forehead skin folds. Treatment options include surgical reduction of skin folds, suspending the brows, enforced secondary granulation of the upper eyelid, or a combination of procedures. Lid-shortening procedures reduce corneal exposure, improve functional blinking and reduce likelihood of traumatic proptosis. Although a lateral canthoplasty is technically easier to perform, a medial canthoplasty is the preferred method of eyelid shortening. An involuted lateral canthus with entropion is seen in certain dog breeds with a broad skull base and redundant facial skin. Surgical correction is by either applying traction to the lateral canthus, or by resection of the lateral canthal ligament. A combination of entropion, ectropion and macroblepharon may result in the presence of diamond shaped eyelids. Surgical correction involves the combination of several procedures. Upper eyelid agenesis is a congenital absence of part of the upper eyelid in cats. Treatment options include a skin-orbicularis flap from the lower eyelid with a conjunctival pedical graft, the transposition of the lower eyelid to the upper eyelid, cross lid flap and subdermal plexus flap, and subdermal collagen injection. Several techniques for reconstruction of upper and lower eyelid defects are described.