Skin grafting in otologic surgery

Abstract

In the postoperative healing phase after auditory canalplasty or open cavity mas to idec tomy, re-epithelialization of these areas may be very slow or problematic. Exposed surfaces may predispose patients to secondary infection and result in recurrent otorrhea. Numerous methods of promoting the healing of the external auditory canal and mastoid cavity after such operative procedures have been explored. One such method is split-thickness skin grafting of the exposed area, a technique first described by Karl Thiersch in the 1800's. In recent years, Thiersch skin grafting has been advocated by numerous investigators. In this review of Thiersch skin grafting, the indications for and methodology of this technique are explored. In 1587, Gasparo Taglacozzi first described the transfer of skin and subcutaneous tissue from one part of the body to another. His landmark publication describing pedicle grafting techniques gave rise to the art of reconstructive surgery. 1 In the late 1800s, Karl Thiersch advanced the techniques of autotransplantat ion. He adapted the pinch graft technique forwarded by Jacques Louis Rieverdin in 1869, developing the concept of splitthickness skin grafting in otologic surgery. 2 In 1893, Siebenmann first advanced the concept of using the Thiersch method of skin grafting in the postoperative mastoid cavity to promote healing. 3 Although such grafting was popular through the early 1900s, it was no longer commonly used by the 1950s. In more recent years, investigators such as Guilford and Wright, 4 Crem5 6 7 13 ers and Smeets, Morris et al, and many others have re-explored the use of split-thickness and full-thickness skin grafts in the repair of the postoperative external auditory canal and mastoid cavity linings. Because of their work the technique of Thiersch grafting has been reborn in the field of otology. Morris et al, in 1992, reported on the experience of 54 patients undergoing Thiersch grafting at the Minnesota Ear Head and Neck Clinic. They proposed that, based on their experience, the use of split-thickness skin grafts in promoting healing of exposed external auditory canal and mastoid cavity surfaces was suited for patients with copious postoperative granulation tissue, a moist, thin epithelium lining the surgical cavity, and persistent otorrhea. They did not recommend the use of grafting if squamous epithelialization had started and was progressing well. In their study, 98% of patients had at least 75% uptake of the grafted material 2 weeks postoperatively, and 86% of patients had complete healing of the area at 1 year. The types of operations leading to grafting in this