RE: Mast cell tumour on upper eyelid of cat

Samantha Lane — Mon, 11 May 2020 19:29:08 GMT

Hi Janine,

Do you have the previous histo results? Does it categorise the MCT on the 2-tier grading scale (Kiupel rather than the three tier Patnaik)?

With regard to surgery, I would enucleate in order to get margins if the entire lid is swollen. I close these with a single pedicle advancement flap and I use a sterile pen to mark this from the wound location, over the top of the head and sometimes as far as the dorsal neck depending on the size of the defect. This can then be slid forwards and the defect generally closes fairly easily. Remember that the longer the flap, the more chance of necrosis/complications.

I would make sure that you have a really big clip as advancing the flap can mean that hair is dragged into the surgical field if the clip is not very large. I also slightly diverge the flap so that the base is broader than the tip. The flap needs to be at least the size of the wound that you are trying to close - a sterile ruler is really helpful here.

When undermining the flap you need to ensure that the SQ tissue and any panniculus muscle is contained within so don't go too superficial with your dissection. I often place a stay suture in the cranial end of the flap on each corner to help with manipulation and avoid any trauma to the tips of the flap and this allows you to check that the flap is long enough. If it is, I then start suturing. Initially I place walking sutures between the flap and the deep tissue. This closes dead space and helps to decrease tension. Once a few of these have been placed and the flap is in the correct position, I start cranially with simple interrupted skin sutures (often in this area another layer of SQ sutures is not needed but if you feel that it is then place those) I use non-absorbable suture e.g. 3-0 ethilon and leave in place for 10 days. There will be dog ears at the base of the flap which you can resect to neaten the appearance before suturing this area.

I hope that helps, let me know if there's anything else I can help with.

Sam