Use of free oral mucosal graft for treatment of feline eyelid agenesis in seven patients

Abstract

ObjectiveTo describe a simple and effective surgery for feline eyelid agenesis.ProcedureFree oral mucosal grafts were harvested from the upper lips of the surgical patients. A recipient bed was created by incising the conjunctiva at the conjunctival‐skin border and opening a space in the tissue with blunt dissection without removal of tissue. The free oral mucosal graft was sutured into the space with simple continuous suture pattern of 7‐0 Vicryl.ResultsEyelids were cosmetically acceptable at final examination, and areas of coloboma appeared less prominent. Patient comfort was improved in all subjects as subjectively noted by decreased blepharospasm. All grafts were successfully incorporated. All patients developed brown‐colored crusting over the grafts within days of the surgery, which gradually resolved over a 4‐ to 6‐week period. Three of seven patients developed few trichiatic hairs at the donor‐recipient junction, and two of these patients had follow‐up cryoepilation.ConclusionFor feline eyelid agenesis, free oral mucosal graft implantation was successful in creating space between fur and cornea with insertion of smooth‐surfaced, hairless tissue, alleviating the discomfort of hair contacting the cornea. The extra tissue can also create a small overhang or fold of tissue (pseudo‐lid) which may also be protective. For two cases, cryoepilation of few trichiatic hairs at the donor‐recipient border was performed at a later date. As illustrated by case 3, use of a long and wide rectangular graft with squared edges is recommended to lessen the chance of trichiasis at lateral or medial edges of recipient‐donor junctions.

Use of subdermal hyaluronic acid injections and a free labial mucocutaneous graft for the repair of feline eyelid agenesis

“…In the opinion of the authors, the use of HA subdermal tissue expansion described in the current report is advantageous as more tissue can be generated between the haired skin and the cornea pre‐operatively, due to mechanical creep, to make post‐operative trichiasis less likely. This is supported by our results as only 1/39 (2.5%) eyelids had trichiasis requiring a general anesthetic to resolve in the form of a Hotz‐Celsus eyelid repair (Figure 7A–H); this is considerably less than the post‐operative trichiasis rates previously reported by Warren et al 15 It is possible that in this single case in our study, the surgical excision to delineate the mucosal surface from the cutaneous surface was located in too close of a proximity to the cutaneous surface, as some germinal hair follicles emerged proximal to the grafted site.…”

“…Our technique differs due to the utilization of HA subdermal tissue expansion in conjunction with this technique. Warren et al reported 2/14 (14.2%) treated eyelids required post‐operative cryoepilation due to ongoing trichiasis 15 . In the opinion of the authors, the use of HA subdermal tissue expansion described in the current report is advantageous as more tissue can be generated between the haired skin and the cornea pre‐operatively, due to mechanical creep, to make post‐operative trichiasis less likely.…”

“…However, the use of this free graft technique in veterinary literature is limited. Previously described use of this technique includes case reports of an upper eyelid repair in a horse following full‐thickness melanoma excision, upper eyelid reconstruction following surgical trauma in a dog, and a case series of 13 eyes in seven cats to repair feline eyelid agenesis 15,22,58 …”

“…Warren et al described a technique of repairing feline eyelid agenesis only using free labial mucocutaneous grafts 15 . Our technique differs due to the utilization of HA subdermal tissue expansion in conjunction with this technique.…”

“…Simple defects can be closed with a one‐step excision of the colobomatous region with simple closure, or frequent lubrication alone if the cornea appears healthy 3,8,23 . However, large colobomatous defects of the eyelid requires extensive repair techniques, with previously described methods including a modified lip commissure to eyelid transposition, a rotational skin graft from the lower eyelid with a conjunctival border, use of 2‐octyl cyanoacrylate with a modified Roberts‐Bistner procedure, cryoepilation, subdermal collagen injection in conjunction with a modified Stades procedure, cross‐lid flap and mucocutaneous subdermal plexus flap or a free oral mucosal graft 9–16 16 …”