Fascia Group Research Articles

MP10-14 LONG-TERM RESULTS OF CYSTOCELE REPAIR WITH SOLVENT-DEHYDRATED CADAVERIC FASCIA OR DERMAL ALLOGRAFT: 559 PATIENTS WITH 4-YEAR FOLLOW-UP

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse1 Apr 2016MP10-14 LONG-TERM RESULTS OF CYSTOCELE REPAIR WITH SOLVENT-DEHYDRATED CADAVERIC FASCIA OR DERMAL ALLOGRAFT: 559 PATIENTS WITH 4-YEAR FOLLOW-UP Saad Juma, Sharon Mee, and Gary Leach Saad JumaSaad Juma More articles by this author , Sharon MeeSharon Mee More articles by this author , and Gary LeachGary Leach More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2344AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With increasing concerns regarding mesh complications, there has been renewed interest in cystocele repair with biologic graft augmentation. There are few studies reporting long-term outcomes of cystocele repair using biologic materials. Herein, we report long-term results of cystocele repair using either non-frozen, solvent-dehydrated (NFSD) cadaveric fascia (Suspend) or dermal allograft (AXIS). METHODS A retrospective analysis was performed on two prospectively maintained databases of women undergoing cystocele repair at two institutions. A total of 992 women underwent cystocele repair between 2000 and 2014. Mean patient age was 65.6 years (range 30 - 99). 559/992 (56.4%) of patients had ≥12 month follow-up by physical exam with mean and maximum follow up of 4 and 11.8 years. 645/992 (65.0%) of patients had ≥12 month follow-up by questionnaire with mean and maximum follow-up of 4.8 and 11.8 years. Pre-op cystocele grades were: G1 - 10 (1.8%), G2 - 121 (21.7%), G3 - 260 (46.5%), G4 - 168 (30.1%). RESULTS Recurrent cystocele (grade 2 or higher using the Baden-Walker system) was seen in 61/559 (10.9%). Prolapse recurrence in anterior and/or apical compartments occurred in 130/559 (23.3%) patients. At the time of last questionnaire, 388/461 (84.2%) patients would repeat surgery and 393/461 (85.2%) would recommend surgery. 71/461 (15.4%) patients were sexually active. Of these, 22 (31%) reported dyspareunia. Significant improvement was demonstrated comparing pre and post-op scores for all questionnaires: IIQ 11 vs. 3.8; UDI 9 vs. 3.8; VAS 2 vs. 5.8 (p<0.05 for all). Complications occurred in 27/559 (4.8%) patients. In the cadaveric fascia group, 24/375 (6.1%) patients had the following complications: 13 vaginal granulation tissue, 4 urinary retention, 2 wound separation, 1 vaginal suture exposure, 1 vaginal sling exposure, 1 infected vaginal hematoma, 1 transient ureteral obstruction, 1 SB injury during SPT placement. In the dermal allograft group, 3/184 (1.6%) patients had the following complications: 1 vaginal allograft exposure, 1 dyspareunia, 1 transient hydronephrosis. CONCLUSIONS With mean and maximum follow-up of 4 and 11.8 years, patients undergoing cystocele repair with either NFSD cadaveric fascia or dermal allograft have excellent and durable results. 76.7% of patients had no significant prolapse recurrence. There was high patient satisfaction and low morbidity. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e107 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Saad Juma More articles by this author Sharon Mee More articles by this author Gary Leach More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation of Autologous Fascia Implantation With Controlled Release of Fibroblast Growth Factor for Recurrent Laryngeal Nerve Paralysis Due to Long-term Denervation.

Paralyzed tissue due to long-term denervation is resistant to many treatments because it induces irreversible histological changes and disorders of deglutition or phonation. We sought to determine the effect of autologous transplantation of fascia into the vocal fold (ATFV) with controlled release of basic fibroblast growth factor (bFGF) on long-term unilateral vocal fold paralysis (UVFP). Unilateral recurrent laryngeal nerve (RLN) section was performed on 20 rats. Five rats were implanted with autologous fascia only (fascia group), and 10 rats were implanted with autologous fascia and a gelatin hydrogel sheet with 1 μg (1 μg bFGF + fascia group) or 0.1 μg (0.1 μg bFGF + fascia group) of bFGF 4 months after RLN section. We evaluated the normalized glottal gap and laryngeal volume and histological changes 3 months after implantation. The normalized glottal gap was significantly reduced in the 3 fascia implantation groups. Normalized laryngeal volume, fat volume, and lateral thyroarytenoid muscle volume were significantly increased in the 2 fascia implantation with bFGF groups. The ATFV with controlled release of bFGF repaired the glottal gap and laryngeal volume after RLN section and may reduce the occurrence of aspiration and hoarseness. We speculate that this treatment improves laryngeal function in long-term RLN denervation.

Butterfly cartilage tympanoplasty: An alternative approach for management of small- and medium-sized perforations

Objective: To evaluate the efficacy of butterfly cartilage tympanoplasty for small- and medium-sized central perforations and compare it with temporalis fascia tympanoplasty. Materials and Methods: A prospective, comparative study was conducted on 110 patients, divided into two groups. Patients of tubotympanic type of chronic suppurative otitis media with 2–6 mm size perforation were included in the study. Fifty-five patients were operated by temporalis fascia Type I tympanoplasty and rest 55 by butterfly cartilage tympanoplasty (transcanal technique) under local anesthesia. Results were compared in terms of pre- and post-operative air-bone gap improvement and success rates. Results: In our study, in terms of outcomes, both techniques had similar results. The success rate was 93.7% in butterfly cartilage tympanoplasty and 96.3% in temporalis fascia group. However, in terms of time taken, butterfly cartilage tympanoplasty took less time (about 30 min) than temporalis fascia (about 55 min). Conclusion: Transcanal butterfly cartilage tympanoplasty is a very good alternative in small- and medium-sized perforations for conventional temporalis fascia tympanoplasty as it is simple, takes less time, day care procedure, on table hearing improvement, cosmetically no postoperative scar, no need of post aural preparation, and patient can go home within hours.

Treatment of tympanic membrane perforation using bacterial cellulose: a randomized controlled trial

IntroductionPromising treatments for tympanic membrane perforation closure have been studied. Therapies derived from tissue engineering probably eliminate the need for conventional surgery. Bacterial cellulose is presented as an alternative that is safe, biocompatible, and has low toxicity. ObjectivesTo investigate the effect on healing of direct application of a bacterial cellulose graft on the tympanic membrane compared to the conventional approach with autologous fascia. MethodsRandomized controlled trial. Forty patients with tympanic membrane perforations secondary to chronic otitis media were included, and were randomly assigned to an experimental group (20), treated with a bacterial cellulose graft (BC) and control group (20), treated with autologous temporal fascia (fascia). We evaluated the surgical time, hospital stay, time of epithelialization and the rate of tympanic perforation closure. Hospital costs were compared. The statistical significance level accepted was established at p<0.05. ResultsThe closure of perforations was similar in both groups. The average operation time in the fascia group was 76.50min versus 14.06min bacterial cellulose in the group (p=0.0001). The hospital cost by the Brazilian public health system was R$ 600.00 for the bacterial cellulose group, and R$ 7778.00 for the fascia group (p=0.0001). ConclusionBacterial cellulose grafts promoted the closure of the tympanic membrane perforations, and were demonstrated to be innovative, effective, safe, minimally invasive, efficacious and to have a very low cost.

A comparison of two myringoplasty techniques in Nepalese children: A prospective randomized trial

BackgroundIn children, the success of myringoplastywith temporalis fascia is lower compared to adults and cartilage as an alternative graft material has shown higher success rate. ObjectiveTo compare results of myringoplasty using tragal cartilage palisades with the use of temporalis fascia in children with large tympanic membrane perforations. Materials and methodsThis is a prospective and randomized study conducted in children of age 6–14 years with large tympanic membrane perforation of more than two quadrants. Status of graft at or around 6 weeks after surgery was used as morphological outcome measure. Pre- and postoperative audiograms were compared to evaluate audiological outcome in two groups. ResultsForty seven out of 55 patients completed follow-up. The graft uptake rate in the cartilage palisades and temporalis fascia myringoplasty group was 91.3% (21/23) and 83.33% (20/24), respectively; the difference was not statistically significant (P=0.666). The mean preoperative air-bone gaps (ABG) in cartilage palisades and temporalis fascia group were 36.2±8.9dB and 33.8±7.5dB, the difference was not statistically significant (P=0.412). Similarly, the postoperative ABG in cartilage palisades and temporalis fascia group were 25.1±12.2dB and 17.2±9.2dB, respectively, the difference was statistically significant (P=0.040). The gap closure was 11.0dB in palisades group and 16.8dB in fascia group, but it was not significant (P=0.133). ConclusionIn our study of pediatric myringoplasty, the morphological and functional outcomes in both cartilage palisades and temporalis fascia groups were comparable.

Boomerang-Shaped Chondro-Perichondral Graft Versus Temporalis Muscle Fascia Graft: Which One is to be Trusted?

The aim of this study was to compare anatomical and audiological results of boomerang-shaped chondroperichondrial graft (BSCPG) with temporal muscle fascia in type 1 tympanoplasties. Sixty-eight patients in BSCPG group and 54 patients in fascia group were evaluated. Otomicroscopic examination was done periodically till 24months as for graft perforation, lateralization and retraction and mean air conduction threshold and airbone gap values were measured. At long term controls, in BSCPG group, rates of neomembrane, perforation, retraction and lateralization were 91.17% (n=62), 8.82% (n=6), 4.41% (n=3) and 0% (n=0), respectively. In fascia group, the corresponding rates were 79.62% (n=43), 20.37% (n=11), 12.96% (n=7) and 3.7% (n=2), respectively. In both groups, mean postoperative PTA and ABG values were significantly better while postoperative same values were significantly different between groups (p=0.044 and 0.032, respectively). Compared to fascia, BSCPG is an ideal grafting technique in the repair of tympanic membrane perforations.

Comparison of Outcomes of Myringoplasty with Cartilage Palisades and Temporalis Fascia in Large Perforations

Objectives: Compare graft uptake rate and postoperative hearing results of myringoplasty using cartilage palisades and temporalis fascia in large perforations. Methods: Prospective, longitudinal, randomized controlled trial from December 2010 to December 2012. at the Ganesh Man Singh Memorial Academy of ENT-Head and Neck Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. Patients were above 13 years of age with chronic otitis media-mucosal (tubotympanic) with &gt;50% perforation of tympanic membrane. Sixty-one cases included for myringoplasty were randomly divided into 2 groups, cartilage palisades and temporalis fascia, by lottery. There were 30 cases in cartilage palisades group and 31 cases in temporalis fascia group. Patients underwent myringoplasty using either cartilage palisades or temporalis fascia. Graft uptake rate and postoperative hearing were evaluated after 12 weeks. Fisher exact test and t test were used as statistical tools. Results: Graft uptake rate in the cartilage palisades group was 86.66% and 90.32% in the temporalis fascia group, with no significant difference ( P = .707) between the 2 groups. The mean pre- and postoperative air bone gaps in the cartilage palisades group were 29.26 dB ± 10.66 and 20.41 dB ± 10.54, respectively. Similarly, in the temporalis fascia group, these were 29.52 ± 11.12 dB and 17.93 ± 8.83 dB, respectively. There was no statistical significance in hearing improvements between the 2 groups ( P = .384). Conclusions: The graft uptake rate and hearing results of myringoplasty with cartilage palisades are comparable to those of temporalis fascia in large perforations.

Comparison of temporal muscle fascia and cartilage grafts in pediatric tympanoplasties

ObjectiveTo compare anatomic and functional outcomes of the different graft materials used in pediatric tympanoplasty. Materials and methodsThe patients younger than 18years of age and who had tympanoplasty between 2010 and 2012 were included in the study. Temporal muscle fascia or cartilage was used as the graft material. The age, gender, the side of the operated ear, the operation technique, pre- and postoperative audiological results, and the status of the graft were noted. An intact graft and an air-bone gap (ABG) ≤20 were regarded as surgical success in the postoperative period. Audiograms obtained before surgery and 1year after surgery were used for the comparison. ResultsSixty pediatric cases were included in the study. Fascia graft was used as the graft material in 35 of them, and cartilage was used in 25 patients. The graft success rate was 82.9% in the fascia group while it was 92% in the cartilage group. In the fascia group preoperative ABG was 28.2±10.1dB, postoperative ABG was 15.1±10.2dB, and postoperative gain was 13.1±9.6dB. In the cartilage group, preoperative ABG was 28.9±10.2dB, and postoperative ABG was 16.8±10.3dB with a postoperative gain of 12.1±6.8dB. The differences between the fascia and the cartilage groups were not statistically significant either for hearing gain or graft success rate. ConclusionCartilage and fascia grafts yield similar results for hearing gain and graft success rate in pediatric tympanoplasty.

Endopelvic fascia preservation during robot-assisted laparoscopic radical prostatectomy: Does it affect urinary incontinence?

Objective. Urinary incontinence has a significant impact on the quality of life after radical prostatectomy. This study aimed to determine whether preserving the endopelvic fascia influences subsequent urinary incontinence. Material and methods. Consecutive patients (n = 138) who underwent robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer between October 2010 and June 2012 with a minimum of 1 year follow-up were retrospectively analysed. The subjects were divided into two groups: the non-preserved endopelvic fascia group (nPE group) and the preserved endopelvic fascia group (PE group). Continence was defined as not using any pads and having no urine leakages. Continence rates at set time-points after RALP were compared using the chi-squared test. Continence recovery rates were analysed with the Kaplan–Meier method and the log-rank test. Prognostic factors of incontinence were identified using the Cox proportional hazards model. Results. The age, body mass index, preoperative prostate-specific antigen levels, prostate volume, estimated blood loss, mean operative time, Gleason score and pathological stage were not significantly different between the two study groups. The continence rate of the nPE group and PE group was 88.4% and 97.1%, respectively, at 12 months after surgery (p = 0.049), which was also significant according to the Kaplan–Meier analysis (p < 0.001). Preservation of endopelvic fascia was the only significant prognostic factor for urinary incontinence (p = 0.002, hazard ratio = 1.867) according to the multivariate analysis. Conclusions. Endopelvic fascia preservation during RALP significantly enhances postoperative continence and is related to the speed of recovery of continence.

Long-Term, High-Frequency Tympanometry and Audiometry Results after Cartilage and Fascia Tympanoplasty

Long-Term, High-Frequency Tympanometry and Audiometry Results after Cartilage and Fascia Tympanoplasty

Temporalis Fascia Versus Cartilage Graft in Myringoplasty = اللفافة الصدغية مقابل الغضروف في ترقيع الطبلة

Objective: The aim of the present study is to compare the surgical and audiological results of temporalis fascia versus conchal cartilage in my ringoplasty. Methods: Arandomized prospective study concerned with 40 patients for whom my ringoplasty have been done. These patients were collected from the Out Patient Department of ENT at Al-Jamhory Teaching Hospital, Mosul/IRAQ from January 2009 to January 2012. Patients were randomly assigned into two groups; in the first group temporalis fascia graft was used (18 patient) whileconchal cartilage graft was used in the second group (22 patients). Results: Our study included 40 patients, 23 males and 17 females. The average age of our patients is 28.4 years with a range from 13- 55 years. Surgical success rates for the first and second groups are 77.78% and 95.45%, respectively. There is19.4 dB improvement in mean hearing threshold in fascia group, compared to 15.2 dB improvement in cartilage group, giving an average of 17 dB improvement in mean hearing threshold of the total series. Conclusions: There was no significant difference neither in surgical success rate nor in hearing gain between the two groups.

Laparoscopic Spleen-Preserving Splenic Hilar Lymphadenectomy Performed by Following the Perigastric Fascias and the Intrafascial Space for Advanced Upper-Third Gastric Cancer

BackgroundLaparoscopic spleen-preserving Splenic hilar lymphadenectomy (LSPL) is required in laparoscopy-assisted total gastrectomy for advanced proximal gastric cancer. However, it is considerably difficult and risk in clinical practice. Thus, we explore the application of LSPL performed by following the perigastric fascias and the intrafascial space in D2 radical gastrectomy for advanced upper-third gastric cancer.MethodsFrom July 2010 to December 2012, 109 patients with T2–3 upper-third gastric cancer underwent LSPL. Of these patients, 55 underwent classic LSPL (classic group), and the remaining 54 patients underwent LSPL performed by following the fascias and intrafascial space (fascia group). Clinicopathologic characteristics and intraoperative and postoperative variables were compared between the two groups.ResultsThere were no significant differences in clinicopathological characteristics between the two groups (P>0.05). All of the operations were successful without conversion to laparotomy. The operation time, mean splenic hilar lymph node (LN) dissection time, mean total blood loss and mean blood loss from splenic hilar LN dissection were significantly lower in the fascia group than in the classic group (P<0.05), whereas the times to first flatus, fluid diet and soft diet and the duration of hospital stay were similar in both groups. The mean number of harvested LNs (No. 10 and No. 11d) was slightly higher in the fascia group, but the difference was not significant. No significant difference in morbidity was found between the fascia group and the classic group (9.3% vs.10.9%, P>0.05). At a median follow-up of 12 months(range 5 to 35 months), none of the patients had died or experienced recurrent or metastatic disease.ConclusionLSPL performed by following the fascias and intrafascial space is an optimal and safe technique based on anatomical logic, and it reduces the difficulties associated with LSPL, making it easier to master and allowing its widespread adoption.

A short-term evaluation between the result of palisade cartilage tympanoplasty and temporalis fascia technique

Introduction: The use of cartilage as a grafting material has been advocated in cases where there is a high risk of graft failure, such as subtotal perforations, adhesive processes, and residual defects after primary tympanoplasties. The purpose of this study was to compare the graft acceptance rates and auditory outcomes of cartilage tympanoplasty operations using a palisade technique with those of primary tympanoplasty using temporalis fascia in a homogenous group of patients. Study Design: Prospective study. Materials and Methods: The study population included 54 patients who were operated on in two groups (palisade technique and temporalis fascia technique) with each group containing 27 patients. Patients with pure subtotal perforations (perforation of >50% of the whole tympanic membrane [TM] area), an intact ossicular chain, at least 1 month dry period, and normal middle ear mucosa were included in the study. Grafts acceptance rates and pre and postoperative audiograms were compared. The follow-up time was 6 months. Results: Graft acceptance was achieved in all patients (100%) in the palisade cartilage tympanoplasty group and in 25 patients (92.5%) in the temporalis fascia group. This difference was not statistically significant ( P = 0.15). Comparison of the increases in mean speech reception threshold, air-bone gap, and pure-tone average scores between both techniques showed no significant changes. Conclusion: Our experience with the palisade cartilage technique demonstrates that subtotal or total perforation at high risk for graft failure can be treated efficiently, and that a durable and resistant reconstruction of the TM with reasonable auditory function can be achieved.

Fascia implantation with fibroblast growth factor on vocal fold paralysis

PurposeThe purpose of this prospective study was to determine the effect of autologous transplantation of fascia into the vocal fold (ATFV) with controlled release of basic fibroblast growth factor (bFGF) on unilateral vocal fold paralysis (UVFP) in a rat model. Materials and methodsUnilateral recurrent laryngeal nerve (RLN) section was performed on 15 rats. Ten rats received an autologous fascia implant and gelatin hydrogel with or without bFGF (1μg) to their larynxes (fascia only, “fascia group”; bFGF+fascia, “fascia+bFGF group”), while the rest underwent RLN transection (“RLN section group”). Four months later, evaluation of the laryngeal glottal gap and histological analysis were performed. ResultsThe glottal gap was significantly reduced in the fascia+bFGF group, and fat volume increased significantly relative to the RLN section. The volume of the remaining fascia in the bFGF+fascia group was significantly greater than that of the fascia group. ConclusionsATFV with controlled release of bFGF may compensate for diminished laryngeal volume in UVFP by reducing resorption of the implanted fascia and increasing fat volume. Our findings suggest that this modality may represent an attractive option for treating UVFP.

Type I tympanoplasty with island chondro-perichondral tragal graft: the preferred technique?

This retrospective, comparative study aimed to assess anatomical and functional results in a group of adults undergoing type I tympanoplasty for subtotal tympanic membrane perforation, using two different types of graft. The study included 106 patients affected by chronic otitis media, who underwent underlay type I tympanoplasty, 53 using an autologous chondro-perichondral tragal graft and 53 using temporalis fascia. Anatomical and functional outcomes were evaluated over time. Audiometric results comparing the cartilage and fascia groups at six months and one year after surgery showed no statistically significant differences. Assessment of anatomical outcomes indicated a greater number of complications in the fascia group. Functional results indicate the validity of the cartilage tympanoplasty, while anatomical results indicate a slightly better outcome in terms of graft re-perforation and retraction, compared with temporalis fascia at one-year follow up. These results suggest that the cartilage technique is preferable for type I tympanoplasty.

Dynamic Mechanical Properties of Tissue after Long-Term Implantation of Collagen and Polypropylene Meshes in Animal Models

Purpose: Pelvic floor reconstructive surgery has grown significantly in recent years. A wide variety of available types of meshes exist but the safety and success has not been adequately proven. We sought to evaluate the effects on dynamic biomechanical properties of tissue after long-term implantation of synthetic and biological grafts. Methods: A total of 96 New Zealand white female rabbits (approximately 3 kg) were used, 72 of which were surgically implanted with acellular, collagen mesh (n = 36) or nonabsorbable monofilament polypropylene mesh (n = 36). There was a no mesh-rupture of fascia group (n = 12) and a second, no-mesh, no-fascia rupture control group (n = 12). In the 59 rabbits, of 72 (13 died) tissue was harvested 3 months (n = 24), 6 months (n = 23) and 9 months (n = 12) later, while in the fascia rupture group, tissue was harvested 6 months later. Tissue samples (2 × 2 cm) underwent dynamic mechanical analysis (DMA) testing during which the dynamic rigidity and tissue damping capacities were measured. The statistical analysis was performed with General Linear Model with Tukeys post hoc testing (sPss v.17.0). Results: With respect to mesh type, the rabbit tissue in which polypropylene mesh was used showed the greatest dynamic rigidity. Those with biological mesh delivered the lowest rigidity results, while the two other groups had almost similar behavior. The meshes exhibited their highest relative dynamic tissue stiffening effect at 9 months. Conclusions: Biological mesh causes lower tissue rigidity, resulting in inferior mechanical response and thus seems to be inferior to polypropylene.

Cartilage graft or fascia in tympanoplasty in patients with low middle ear risk index (anatomical and audological results)

The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients with low middle ear risk index (MERI). In this retrospective study, 63 patients that underwent type 1 tympanoplasty with chondroperichondrial island graft between July 2009 and November 2010 were compared with 45 patients in whom temporal muscle fascia was used. Patients in both groups had low MERI values varying between 1 and 3. Five and nine patients underwent masteidectomy in cartilage and fascia group, respectively. Mean duration of follow-up was 11.9±3.7 (5-17) months. Mean value was calculated at pre-operative and post-operative hearing threshold 0.5, 1, 2, 4kHz, and air bone gap (ABG) gain was compared in both cartilage and fascia groups. when pre-operative and post-operative ABG gain were compared, significant decrease was seen in ABG levels (p<0.001). However, no significant difference was seen in ABG gain values (p=0.608), which was 10.1±7.00dB in cartilage group and 10.8±5.38dB in fascia group. In both groups, age, sex, and the addition of mastoidectomy procedure had no significant effect on ABG gain and success. Cartilage is a graft material that may be preferred without concern about the effects on hearing results, especially, in patients with low MERI values. The addition of mastoidectomy had no impact on the outcome of operation and audiological results. However, further studies with larger case series may be carried out to further clarify the issue.

Application of hyperdry amniotic membrane patches without fibrin glue over the bony surface of mastoid cavities in canal wall down tympanoplasty

Conclusion: Fibrin glue might be an inessential bioadhesive for attachment of hyperdry amniotic membrane (AM) patches in canal wall down (CWD) tympanoplasty. Objective: To clarify the pliability and adherence capability of human hyperdry AM, the feasibility of fixing hyperdry AM without fibrin glue to the bony surface of the mastoid cavity was evaluated in CWD tympanoplasty. Methods: This was a retrospective chart review. In seven ears of seven patients, the AM was simply attached over the bony surface of the mastoid cavity without fibrin glue (AMG(–) group). In 22 ears of 20 other patients, hyperdry AM (11 ears of 11 patients, AMG(+) group) or temporal fascia (11 ears of 9 patients, TFG(+) group) was attached over the bony surface of the mastoid cavity with fibrin glue. Times for graft epithelization were compared among the three groups. Results: Complete epithelization of the mastoid cavity took place in all patients in all three groups. The mean time to complete epithelization of the graft in the AMG(–) and AMG(+) groups was significantly faster than that in the TFG(+) group (p < 0.05) and was not significantly different between the two AM groups (p > 0.05).

Fascia Versus Cartilage Graft in Type I Tympanoplasty

Various materials such as fascia, perichondrium, and cartilage have been used for reconstruction of the tympanic membrane in middle ear surgery. Because of its stiffness, cartilage is resistant to resorption and retraction. However, cartilage grafts result in increased acoustic impedance, the main limitation to their use. The aim of this study was to compare the hearing results after cartilage tympanoplasty versus fascia tympanoplasty. This study included 114 patients without postoperative tympanic membrane perforation who underwent tympanoplasty type I between 2007 and 2010, 31 with fascia and 83 with cartilage. Preoperative and 1 year postoperative air-bone gap (ABG) and postoperative gain in ABG at frequencies of 0.5, 1, 2, and 3 kHz were assessed. Both groups were statically similar in terms of the severity of middle ear pathology and the preoperative hearing levels. Overall, postoperative successful hearing results showed 77.4% of the fascia group and 77.1% of the cartilage group. Mean postoperative gains in ABG were 9.70 dB for the fascia group and 9.78 dB for the cartilage group. These results demonstrate that hearing after cartilage tympanoplasty is comparable to that after fascia tympanoplasty. Although cartilage is the ideal grafting material in problematic cases, it may be used in less severe cases, such as in type I tympanoplasty, without fear of impairing hearing.

Comparison of Different Grafting Techniques in Type I Tympanoplasty in Cases of Significant Middle Ear Granulation

To assess anatomical and hearing results after different reconstruction methods of tympanic membrane in cases of severe middle ear granulation. Retrospective review. Secondary care medical center. Forty patients with severe middle ear granulation were included. Canal wall-up mastoidectomy with Type I tympanoplasty. Temporalis fascia was used in 22 patients, cartilage island flap was used in 10 patients, and cartilage palisade was used in 8 patients. Graft take, air-bone gap, and air-bone gap closure ratio of 50% or more. In the fascia group, the graft take rate was 91%, whereas the graft take rate for the cartilage island group and the cartilage palisades group was 100% (p = 0.617). Mean ± SD preoperative air-bone gaps for the fascia, island flap, and cartilage palisades were 30 ± 9.4, 26 ± 11.7, and 25 ± 10.8 dB, respectively. Postoperative air-bone gaps were 17 ± 10.2, 14 ± 8.4, and 19 ± 7.5 dB, respectively, in the same order. The cartilage palisades group failed to show statistically significant difference between preoperative and postoperative air-bone gaps (p = 0.195). Air-bone gap closure ratio of 50% or more was found in 11 cases (50%) of the fascia group, in 5 cases (50%) of the island flap group, and in 1 case (13%) of the cartilage palisades group. Cartilage palisades showed reliable graft take but slightly poor hearing results. Thus, fascia or cartilage island grafting might be better for tympanoplasty in cases of severe middle ear granulation tissue.