H plasty can be used for periocular mass removal and is a means of recreating the eyelid margin. It may be used to control tumors or when the other eye is already enucleated.
The eyelid margin includes meibomian glands and eyelid musculature.
Food restrictions: 48 hours for cattle, 6-12 hours for horses
NSAIDs/analgesics: Preoperative NSAIDs are necessary for swelling management.
Antibiotics: Optional depending upon the tumor appearance and environment.
Tetanus prophylaxis is recommended for horses.
Local blocks: The palpebral nerve is blocked to allow eyelid manipulation but does not provide analgesia. The supraorbital nerve is blocked to provide analgesia to the upper lid. Lower lid lacerations are usually blocked with regional anesthesia.
Position/preparation: Patients are generally placed under general anesthesia. Eye lube is used to protect the cornea. The area is prepped using betadine solution rather than scrub. Avoid chlorhexidine (toxic to the cornea) and alcohol. Use saline to remove the betadine. The eyelashes may be trimmed if needed but rarely is further clipping required. Surgeons glove.
- Standard surgery pack
- 3-0 or 4-0 soft suture material, cutting and taper needles
- headlamp or surgery lighting
- tongue depressor (pushed under the lid to create a firm surface for incisions)
The triangles should be 20% longer than the incision adjacent to the tumor (full length 120% of tumor).
The flap margins can be closed using the figure 8 suture pattern to avoid suture near the cornea.
- Keep the patient from rubbing on the eye
- Suture removal in 10-14 days
- NSAIDs for at least 3 days to minimize swelling and dehiscence.
- tumor recurrence
- suture dehiscence
- keratitis from sutures or uneven eyelid margin
Basic ophthalmic surgery procedures, Veterian key
sutured edges come apart; lack of healing of incision