Tympanic membrane grafting with fascia: overlay vs. undersurface technique.

Abstract

AbstractEarly attempts to repair tympanic membrane perforations were not uniformly successful. At first, full thickness and later split thickness skin was used as an overlay graft. The many problems associated with this material soon led most surgeons to seek a substitute. Over the years canal skin and connective tissue (particularly fascia) became popular, and two grafting techniques developed. The use of connective tissue made it possible to place the graft under the drum remnant as well as over.There are some difficulties associated with both procedures. When fascia is placed over the drum remnant several problems such as anterior sulcus blunting, graft lateralization, epithelial pearls and delayed healing may occur. The undersurface procedure is technically more difficult, and error in graft placement accounts for many of the failures that occur with this method.This paper discusses both classic techniques in general terms, stressing the advantages and disadvantages of both. By combining some features of each technique and by employing the postauricular approach, a method of undersurface grafting in presented that has consistently produced good tympanic membranes. Results (take rate and quality of drum head) are described in 237 cases in which both techniques of grafting were used.