Reconstruction of the lower eyelid by third eyelid lateral advancement and local transposition cutaneous flap after en boc 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.