Restoration of function following traumatic superior eyelid avulsion in a horse treated with advancement flap blepharoplasty (H-plasty) and subdermal hyaluronic acid filler.

OBJECTIVE: To describe the successful restoration of superior eyelid function in a horse following traumatic avulsion using an advancement flap blepharoplasty and subdermal hyaluronic acid filler. ANIMAL STUDIED: A 21-year-old American Paint Horse stallion who was attacked by a fellow stallion resulting in numerous traumatic injuries including avulsion of approximately 75% of the left superior eyelid. PROCEDURES: With standing sedation and locoregional anesthesia, the superior eyelid wound was debrided and an advancement flap blepharoplasty (H-plasty) and temporary tarsorrhaphy were performed. Routine healing of the surgical site occurred over the subsequent weeks, though lagophthalmos persisted. At 2 and 4 weeks post-operatively, 2.4% cross-linked hyaluronic acid was injected subdermally into the superior eyelid to attempt to improve corneal coverage. At 8 weeks post-operatively, a complete blink was restored and the cosmetic outcome was good. CONCLUSIONS: Injection of subdermal hyaluronic acid filler following eyelid injuries or blepharoplastic procedures that result in lagophthalmos can improve corneal coverage by the eyelids and allow for maintenance of a comfortable and visual eye.

Novel use of a combination of extracellular matrices for wound healing following resection of a large inferior eyelid mass in a miniature Hereford.

CASE DESCRIPTION: A 9-month-old miniature Hereford heifer was evaluated for a mass on the right inferior eyelid that had progressed in size over 3 months. CLINICAL FINDINGS: Physical examination revealed a firm, ulcerated, pedunculated mass on the right inferior eyelid that extended from the medial quarter to beyond the lateral canthus of the eye. The base of the mass measured 7.4 × 6.7 cm, and the dorsal margin of the base of the mass was approximately 3 mm ventral to the inferior eyelid margin. Histologic evaluation of incisional biopsy specimens from the mass was consistent with fibrosarcoma. TREATMENT AND OUTCOME: The mass was surgically resected with care taken to preserve the eyelid margin. The resulting 10 × 8.5-cm surgical wound was treated with adjunct CO2 laser therapy and closed by primary closure at its medial and central aspects and placement of a 4.6 × 2.6-cm lyophilized equine amnion multilayer graft and 2 sheets of 4-ply porcine small intestinal submucosa at its lateral aspect. The grafts were kept moist by alternating topical antimicrobial and artificial tear ointments for 3 weeks. The wound healed without complications, resulting in a functional and aesthetically pleasing outcome despite the development of moderate ectropion at the lateral aspect of the inferior eyelid. CLINICAL RELEVANCE: Results suggested that a combination of extracellular matrix scaffolds may be an alternative to extensive skin flaps for management of large dermal wounds, particularly wounds resulting from blepharoplasty where preservation of an eyelid margin is desired.

Use of a chronic soft tissue expansion device to facilitate blepharoplasty in a horse with lower-lid cicatricial ectropion with a 14-year follow-up.

A 3-year-old Thoroughbred filly presented to a referral equine hospital for surgical correction of a severe cicatricial lateral lower eyelid ectropion OD, with secondary exposure keratitis. The severity of the ectropion deemed that conventional ectropion repairs would be unsuccessful. Therefore, a soft tissue expansion device was used to create sufficient local tissue for a rotational graft with tension-relieving horizontal incisions to be performed to facilitate closure and acceptable eyelid apposition. The keratitis had resolved by two months postoperatively. There were no long-term complications and only mild recurrence of the keratitis observed 14-years postoperatively.

Shared rhytidectomy continued to lateral canthoplasty in a Mastiff with excessive facial folding and macroblepharon.

A 3.5-year-old male Neapolitan Mastiff was presented with an obstructed visual axis because of excessive facial skin folds, brow droop, macroblepharon, upper eyelid entropion and lower ectropion-entropion. To address these major defects a technique was performed which combines rhytidectomy with shortening of the palpebral fissure and stabilization of the lateral canthus. Postoperatively the dog showed an unobstructed visual axis with comfortable and symmetrical eyes.

Lip commissure to eyelid transposition for repair of feline eyelid agenesis.

Repair of eyelid agenesis in nine eyes of five cats using a lip commissure to eyelid transposition is described. The procedure is a modification of the technique described by Pavletic for reconstruction of the canine inferior eyelid and provides skin, mucosa, a mucocutaneous junction, and muscle to reconstruct the superior and inferior eyelid and lateral canthus. The technique was successful in all eyes and resulted in improvement in corneal protection, cosmesis and in several cats a return of the palpebral reflex.

Blefaroplastia em coelhos por meio de cartilagem auricular alógena conservada em solução saturada de NaCl / Rabbits eyelid repair by means of alogen auricular cartilage preserved in NaCl saturated solution

Avaliou-se a reconstrução da pálpebra inferior de coelhos, com cartilagem auricular alógena, conservada em solução saturada de NaCl em 12 coelhos, adultos, de ambos os sexos. Os animais receberam acepromazina (0,5mg/kg/IM) e tiletamina e zolazepam (7,0mg/kg/IM), após o que removeu-se um fragmento de 1,0x0,5cm das pálpebras inferiores, esquerda e direita. A pálpebra esquerda foi reparada pela técnica de blefaroplastia em H (GC) e a direita por um retalho de cartilagem auricular associado a blefaroplastia em H (GE). Aos sete dias de pós-operatório (PO), as feridas cirúrgicas dos animais do GC apresentavam retração cutânea. Aos 15 dias de PO, observou-se que as feridas nos coelhos do GE estavam cicatrizadas, mas 30 por cento das do GC apresentavam deiscência e retração cicatricial. Aos 30 dias de PO, as feridas nos animais do GE e GC apresentavam-se cicatrizadas, mas, 30 por cento nos do GC não apresentavam as bordas das feridas coaptadas. O enxerto de cartilagem auricular diminuiu a retração cicatricial, possibilitando reparo anatômico à pálpebra

The rabbit inferior eyelid repair was evaluated using NaCl satured-stored alogenous auricular cartilage. Twelve adult male and female rabbits had a 1.0x0.5cm fragment removed from the left and right inferior eyelids after pre-medication with acepromazine (0.5mg/kgIM) and tiletamine-zolazepan (7.0mg/kgIM) anesthesia. The "H" plasty technique was used to the left eyelid repair (CG) and the right one was repaired with auricular cartilage associated with the "H" plasty technique (GG). The CG wounds presented cutaneous retraction at day 7th of the post-operative period. The GG wounds were healed on the day 15th, while the CG wounds presented 30 percent of deiscence and cicatricial retraction. The GG and CG wounds were healed at day 30th of the post-operative period, but 30 percent of the CG wounds did not present the edges lined up. It was concluded that the auricular cartilage graft decreases cicatricial retraction and improves anatomical eyelid repair

Reconstruction of the lower eyelid by third eyelid lateral advancement and local transposition cutaneous flap after "en bloc" resection of squamous cell carcinoma in 5 cats.

OBJECTIVE: To describe a novel technique for blepharoplasty to cover a tissue defect involving >/=50% of the lower eyelid. STUDY DESIGN: Prospective clinical study. ANIMALS: Five cats with lower eyelid squamous cell carcinoma (SCC). METHODS: En bloc resection of SCC by removing >/=50% of the lower lid with either the medial or lateral canthus was performed without other adjunctive treatment for SCC. The lid defect was reconstructed with a transposition skin flap derived from the frontal (medial defect) or temporal (lateral defect) region. The third eyelid was advanced laterally without dissection from its insertion; its outer conjunctival layer was removed, and the skin flap was sutured with single interrupted sutures dorsally over the nictitating membrane, ventrally to the cutaneous edge of the surgical wound and medially or laterally (depending on the canthus removed) to the skin of the remaining lower lid. RESULTS: Satisfactory cosmetic and functional results were achieved and the Schirmer tear tests were normal. In 2 cats, the skin flap needed monthly hair trimming to avoid corneal lesions. CONCLUSIONS: After en bloc resection of SCC involving >/=50% of the lower eyelid, reconstruction can be achieved by relocation of the third eyelid and use of a cutaneous transposition flap sutured to the scarified external surface of the third eyelid. Eyelid apposition and lacrimal function were preserved. CLINICAL RELEVANCE: Blepharoplasty using a cutaneous transposition flap sutured to the scarified surface of a relocated third eyelid should be considered for reconstruction of lower eyelid defects with >/=50% tissue loss of the lid margin.