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Reconstruction technique of the upper eyelid in three cats

Del Magno S, Giuseppe P, Pisani G, Morello E, Piras LA, Buracco P, et al. Caudal Auricular Axial Pattern Flap for the Reconstruction of the Upper Eyelid in Three Cats. J Am Anim Hosp Assoc [Internet]. 2020 May 15 [cited 2020 May 19];JAAHA-MS-6987. 

Surgery remains a mainstay of therapy for many malignant tumors, as resection of a tumor can lead not only to remission, but to cure. For tumors in many anatomic locations, surgery remains difficult due to proximity to major blood vessels, organs, or important structures. Tumors of the eyelid or periorbital region are traditionally viewed as difficult to resect with clean margins without concurrent removal of the eye (exteneration) or adjuvant radiation therapy. A “lip to lid” flap has been used to restore small defects, however it is not suitable for larger resections. This paper describes the use of a type of skin graft (caudal axial graft pattern) to allow resection of an upper eyelid mass in cats while preserving the globe and avoiding radiation therapy.

Surgery in three cats is described. All of these cats were diagnosed with malignant tumors, and owners declined both exenteration or marginal excision with follow-up radiation.  Two of the cats presented for squamous cell carcinoma of the eyelid, and the third for a malignant schwannoma. All cats received pain control and antibiotics prior to surgery. A 10-12 x 4-5 cm flap was prepared from the dorso-lateral neck and advanced medial to the ear in one cat and ventrally in two cats.  The flap was sutured to the medial and lateral canthus in two cats, and also to the conjunctiva in a third cat.

Photos available in the article demonstrating the technique.

Two of the three cats had minor corneal ulcers develop post surgically which recovered with routine therapy. All cats had reduced but present ability to blink. One cat initially developed trichiasis managed with hair trimming, however it was discovered that the cat did better with longer hair and this was discontinued.

One cat with squamous cell carcinoma had a second carcinoma develop near the initial excision 807 days post-surgery; this cat died of alimentary lymphoma 6 years later. The other cat with SCC had recurrence in 380 days, followed by exteneration and eventual euthanasia due to chronic kidney disease (CKD) 763 days after the first surgery. The cat with malignant schwannoma experienced a recurrence 350 days after surgery and was then lost to follow up.

This manuscript suggests that a caudal axial flap surgery after wide excision of eyelid masses is an effective technique in cats. It is associated with median disease-free survival times in excess of one year and minimal side effects. Further work is needed to investigate this technique prospectively and compare it to other surgical techniques for these conditions. (MRK)

See Also

Aquino SM. Management of eyelid neoplasms in the dog and cat. Clin Tech Small Anim Pract 2007;22:46–54.