Thiersch Graft Research Articles

Acquired atresia of the external auditory canal and canaloplasty with Thiersch graft reconstruction: Outcomes and complications.

Acquired atresia of the external auditory canal (EAC) is a rare disease characterized by otorrhea and progressive hearing loss. Clinically, it is differentiated into two stages: the wet stage and the dry stage. The dry stage does not respond to pharmacological treatment and has to be treated surgically. One surgical option is canaloplasty of the EAC with Thiersch graft reconstruction. This study aimed to report the follow-up outcomes (otomicroscopic signs and pure tone audiometry [PTA]) in patients with acquired atresia treated with this technique. Eighteen adult patients surgically treated for acquired atresia of the EAC between 2010 and 2020 were enrolled. All underwent canaloplasty with Thiersch graft reconstruction by one senior surgeon. Otomicroscopy and PTA results were evaluated before and after surgery. Postsurgical follow-up was performed at 1-3-6-12 months and then annually. Presurgical otomicroscopic examination revealed stenosis that occluded more than 75% of the EAC in all patients, and preoperative PTA showed conductive hearing loss in 89% of patients. However, postsurgical otomicroscopic examination showed that 94% of patients had a normal EAC diameter after one year, and only one patient had anterior blunting and recurrent atresia. In addition, postsurgical PTA evidenced a normal range in 89% of patients after one year. In conclusion, acquired atresia of the EAC is a troublesome disease usually associated with hearing loss. Therefore, treatment is chosen to resolve its symptoms. The results demonstrate evidence that canaloplasty with Thirsch graft may be a suitable surgical method considering the lower incidence of recurrence and the excellent hearing outcomes.

Thiersch graft follow-up with narrow band imaging for acquired atresia of the external auditory canal: Canaloplasty with Thiersch graft versus vascularization evaluated with narrow band imaging.

Acquired atresia of the external ear canal (EAC) is defined as a narrowing caused by abnormal production of soft or bony tissue. EAC has two different phases, a wet one and a dry one. A computed tomography (CT) scan may show images where the soft tissue fills the EAC. Treatment with CT may be medical and/or surgical. The surgical technique most widely adopted is canaloplasty with a skin free flap. To the best of our knowledge, no previous article has reported data analyzing the vascularization of acquired atresia of the EAC and vascularization of the skin flap during follow-up with narrow-band imaging (NBI). This paper aimed to study post-surgical vascularization of the skin graft, with NBI endoscopy, to identify any eventual areas with less perfusion that may lead to degeneration and fibrosis. Patients suffering from acquired atresia of the external auditory canal, surgically treated in the Department of Organi di Senso of Sapienza University, from 2017 to 2020 were enrolled. All patients underwent anamnestic collection, physical examination, and mastoid CT. Pre- and post-operative otoendoscopic evaluations (at 1, 3, 6 and 12 months) were performed with both cold white light (CWL) and NBI endoscopic vision. 17 patients were enrolled in the study. Pre-operative otoendoscopic examination of CWL showed stenosis with a diameter <75% and a tympanic membrane not viewable in all patients. At 12 months of follow-up, 94% of patients had no recurrence of EAC stenosis. 88% of patients presented an adequate vascularization by NBI. Our study aimed to evaluate whether the NBI endoscopic view and the analysis of vascularization may be useful for improving the prognosis of patients surgically treated with canaloplasty and Thiersch graft for acquired atresia of EAC, concerning the single analysis using CWL endoscope.

Les pseudarthroses infectées du tibia: évaluation de la méthode d’Ilizarov avec compression distraction sans geste de débridement local

BackgroundThe treatment of infected nonunion requires radical debridement with stable fixation. Sever soft tissue compromise of the nonunion site might interfere with radical debridement. This study discussed the outcome of treatment of infected tibial nonunion with sever soft tissue compromise by a cyclic compression distraction technique using Ilizarov without radical debridement. MethodsThis study comprised 17 patients with unilateral infected tibial nonunion; 10 with diaphyseal and 7 with metaphysial locations. Their mean age was 21.9 years. There were 12 males and 5 females. The right side was affected in 11 patients and the left side in 6 patients. According toGustilo and Anderson classification, all patients were grade III. The mean limb shortening was 1.3cm. All patients were treated initially in another institute by uniplanner external fixator with rotational skin flap done in 11 patients and thiersch graft in 6 patients. One patient had common peroneal nerve affection. Distal circulation was sufficient in all patients. None of our patients had chronic diseases. Two to three cycles of gradual distraction compression were done. Each cycle consisted of distraction, followed by compression, then distraction, and lastly compression. The mean follow up period was 29.35 months. ResultsUnion was achieved in all patients at a mean time of 23.9 weeks. According to Hammer et al.; there were 8 patients with grade 1, and 9 patients with grade 2. According to Johner and Wruhs’ criteria; the outcome was excellent in 6 patients, goodin 3 patients, poor in 4 patients, and fair in 4 patients. Complications had occurred as pin tract infection(47.1%), persistent discharging sinus (5.9%), and valgus ankle deformity (11.8%). Refracture did not occur in any case till the final follow up. ConclusionAlthough debridement is essential in the treatment of infected tibial nonunion, it could harm the limb in severe soft tissue compromise. Cyclic compression distraction by Ilizarov had a satisfactory outcome in the treatment of such cases through enhancement of a biological environment to achieve union. Level of evidenceIV; prospective case series.

Infected Tibial Nonunion: Assessment of compression distraction Ilizarov technique without debridement

BackgroundThe treatment of infected nonunion requires radical debridement with stable fixation. Sever soft tissue compromise of the nonunion site might interfere with radical debridement. This study discussed the outcome of treatment of infected tibial nonunion with sever soft tissue compromise by a cyclic compression distraction technique using Ilizarov without radical debridement. MethodsThis study comprised 17 patients with unilateral infected tibial nonunion; 10 with diaphyseal and 7 with metaphysial locations.Their mean age was 21.9 years. There were 12 males and 5 females. The right side was affected in 11 patients and the left side in 6 patients. According toGustilo and Anderson classification, all patients were grade III. The mean limb shortening was 1.3cm. All patients were treated initially in another institute by uniplanner external fixator with rotational skin flap done in 11 patients and thiersch graft in 6 patients. One patient had common peroneal nerve affection. Distal circulation was sufficient in all patients. None of our patients had chronic diseases. Two to three cycles of gradual distraction compression were done. Each cycle consisted of distraction, followed by compression, then distraction, and lastly compression. The mean follow up period was 29.35 months. ResultsUnion was achieved in all patients at a mean time of 23.9 weeks. According to Hammer et al.; there were 8 patients with grade 1, and 9 patients with grade 2. According to Johner and Wruhs’ criteria; the outcome was excellent in 6 patients, goodin 3 patients, poor in 4 patients, and fair in 4 patients. Complications had occurred as pin tract infection (47.1%), persistent discharging sinus (5.9%), and valgus ankle deformity (11.8%). Refracture did not occur in any case till the final follow up. ConclusionAlthough debridement is essential in the treatment of infected tibial nonunion, it could harm the limb in severe soft tissue compromise. Cyclic compression distraction by Ilizarov had a satisfactory outcome in the treatment of such cases through enhancement of a biological environment to achieve union. Level of evidenceIV; prospective case series.

A true silent compartment syndrome in a competent sensate patient: Case report

A true silent compartment syndrome in a competent sensate patient: Case report

Thiersch Skin Grafting in Otologic Surgery

Thiersch skin grafting is an old but highly effective surgical technique in otology. We frequently place a Thiersch graft after otologic procedures that either create a mastoid cavity or result in reduced skin coverage of a portion of the external auditory canal. The purpose of this article is to introduce this surgical technique to a new generation of otologists. We discuss its indications, the surgical technique, tips for a successful outcome, and postoperative care. A key to successful skin grafting is to perform the procedure about 10 days after the primary procedure to allow sufficient time for the formation of an adequate vascular bed at the recipient site. The goal in all cases is to achieve a safe, dry ear that is covered with keratinizing squamous epithelium. Thiersch grafting accomplishes this very well.

Rapid Progressive Extramedullary Plasmacytoma in the Orbit

BACKGROUND: Plasma cell tumors of the orbit are uncommon and mostly the first manifestation of a multiple myeloma (MM). Primary extramedullary plasmacytoma (EMP) of the orbit is exceedingly rare and only a few cases have been reported so far. Differentiation of an EMP from a MM is important, since 9.5 years have been reported as the mean survival of EMP, compared with a mean survival of 3 to 4 years for multiple myeloma. HISTORY AND SIGNS: A 68-year-old man presented with a history of rapid progressive extramedullary plasmacytoma in the right orbit, increasing in size within a few weeks. MR imaging revealed an intraorbital mass measuring 5.2 × 4.7 × 3 cm. The earlier performed biopsy was positive for plasmacytoma of the lambda light chain type. Systemic work-up was negative for further tumor spread. THERAPY AND OUTCOME: Irradiation (a maximum of 80 Gy) and several chemotherapy cycles showed no effect. Exenteration with sparing of the upper and lower lid skin was performed. The residual defect was covered by a Thiersch graft. Although the orbit had been irradiated with the maximal dose, the Thiersch graft healed well. CONCLUSION: Normally, EMP is slow to increase in size. In our patient, marked growth of tumor was noted within one week. One underlying reason is the poorly differentiated, blastic morphology leading to this rapid tumor growth. However, particular molecular features, like a t(4;14), could not be demonstrated.

Rapid Progressive Extramedullary Plasmacytoma in the Orbit

Plasma cell tumors of the orbit are uncommon and mostly the first manifestation of a multiple myeloma (MM). Primary extramedullary plasmacytoma (EMP) of the orbit is exceedingly rare and only a few cases have been reported so far. Differentiation of an EMP from a MM is important, since 9.5 years have been reported as the mean survival of EMP, compared with a mean survival of 3 to 4 years for multiple myeloma. A 68-year-old man presented with a history of rapid progressive extramedullary plasmacytoma in the right orbit, increasing in size within a few weeks. MR imaging revealed an intraorbital mass measuring 5.2 x 4.7 x 3 cm. The earlier performed biopsy was positive for plasmacytoma of the lambda light chain type. Systemic work-up was negative for further tumor spread. Irradiation (a maximum of 80 Gy) and several chemotherapy cycles showed no effect. Exenteration with sparing of the upper and lower lid skin was performed. The residual defect was covered by a Thiersch graft. Although the orbit had been irradiated with the maximal dose, the Thiersch graft healed well. Normally, EMP is slow to increase in size. In our patient, marked growth of tumor was noted within one week. One underlying reason is the poorly differentiated, blastic morphology leading to this rapid tumor growth. However, particular molecular features, like a t(4;14), could not be demonstrated.

Treatment of postinflammatory acquired atresia of the external auditory canal.

In 11 patients postinflammatory acquired atresia of the auditory canal, 7-15 mm thick, was excised, the drum and auditory canal covered with a Thiersch graft alone or by fascia and a Thiersch graft. 2.5-5 years after the operation there was no case of recurrence of the atresia. The functional result was most favourable in cases with atresia of minor thickness. Early operation is recommended, especially as cholesteatoma was found behind the atresia in 2 patients.

The Surgical closure of exposed skull

The closure of scalp defects is still surrounded by many uncertainties. Free skin graft has proved most successful. Thiersch graft, split skin graft and full thickness skin graft have their indication for use. Thiersch skin graft is used as a temporary dressing, in order to achieve aseptic wound conditions, but cannot be looked upon as a lasting solution cosmetically and functionally. Split skin is used only for the closure of smaller defects. Full thickness skin grafts are most suitable, because they offer a lasting coverage, which meets to all demands. If the outer table of the skull is exposed, multiple bur holes could be placed immediately in cases of fresh injuries, and these facilitate the growth of granulation tissues which nourish the outer table adequately, so that it remains viable. Exposure of the outer table of the skull for a long time leads to necrosis of the superficial layer. It must therefore be removed down to the diploe with a chisel, or brought to early sequestration by means of numerous perforations made with a bur. Skin should not, however, be placed on the exposed diploe immediately, but it should be allowed to granulate, so as to produce a layer of fibrous tissue beneath the grafted full thickness skin. Thus a direct adhesion to the bony underlayer is prevented, and the skin remains movable. The danger of pressure ulcer is also prevented. The figures show the surgical procedure.

The surgical closure of exposed skull

The closure of scalp defects is still surrounded by many uncertainties. Free skin graft has proved most successful. Thiersch graft, split skin graft and full thickness skin graft have their indication for use. Thiersch skin graft is used as a temporary dressing, in order to achieve aseptic wound conditions, but cannot be looked upon as a lasting solution cosmetically and functionally. Split skin is used only for the closure of smaller defects. Full thickness skin grafts are most suitable, because they offer a lasting coverage, which meets to all demands. If the outer table of the skull is exposed, multiple bur holes could be placed immediately in cases of fresh injuries, and these facilitate the growth of granulation tissues which nourish the outer table adequately, so that it remains viable. Exposure of the outer table of the skull for a long time leads to necrosis of the superficial layer. It must therefore be removed down to the diploe with a chisel, or brought to early sequestration by means of numerous perforations made with a bur. Skin should not, however, be placed on the exposed diploe immediately, but it should be allowed to granulate, so as to produce a layer of fibrous tissue beneath the grafted full thickness skin. Thus a direct adhesion to the bony underlayer is prevented, and the skin remains movable. The danger of pressure ulcer is also prevented. The figures show the surgical procedure.

Half-nose; a very rare congenital anomaly

Aplasia of the nose is a very rare, congenital anomaly in our field. It emerges as a complete absence of the external nose and all nasal cavities on both sides, or an absence of one half of the nose and its associated nasal cavity. The latter case is called; “halfnose.”Etiologically, it is akin to tubular proboscis, anomaly with a snout-like nasal appendage on, or by the mid-line of the face. Tubular proboscis is caused by a failure of the embryonal frontonasal process to migrate downward, and aplasia occurs when the frontonasal process and nasal sac fails to develop due to the same and more severe cause.Hitherto, only several clinical cases of aplasia have been reported in the literatures.Here a case of half-nose was reported. The patient was a five-year-old girl born with congenital absence of the left external nose and nazis. Moreover, her appearance was featured by epiphora only from the left eye. Left choanal atresia was found by posterior rhinoscopy. X-ray examination revealed complete absence of the nasal cavity, accessory sinuses and nasolacrymal duct on the same side. Systolic heartmurmur by auscultation suggested some congenital heart anomaly, but chest X-ray examination and electrocardiography presented no pathological findings. She had no other serious diseases since the birth. She was one of three offsprings of healthy parents without consanguineous marriage. The two siblings were normal. In the family-tree no other patient of congenital malformation could be seen.Concerning surgical procedures, intervention to the bony tissues of such a young patient should be avoided not to disturb a further growth of the facial bone. Then, plastic surgery was carried out only on the external nose in April, 1966. Under general anesthesia, incision was made on the left cheek, and tongueshaped pedicle skin flap was raised up. The nasal septum was exposed, on the left side there could be seen no nasal cavity but bony tissues. The left nasal ala was made of the pedicle flap by V-Y suture method. The new nais was lined with free Thiersch graft taken from the thigh. The wound healed up with satisfying result, and the patient left the hospital in June, 1966.

Reconstruction of ear canal in surgery for chronic ear.

Tympanoplastic procedures have now been practiced for more than 10 years, and most of the surgical methods are already well standardized. Excellent descriptions of different alternatives are given in textbooks on ear surgery by Shambaugh¹and by Portmann, Portmann, and Claverie.²In evaluating the results, the Wullstein classification into 5 different types is generally used. The experience in our clinic with these procedures has been reported for 2 periods, 1950-1952 (Palva and siirala, 1954.³) and 1953-1958 (Palva and Pulkkinen, 1960^4-5). During the first period, myringoplasty and columellization were the standard procedures. The cavum minor technique with a full thickness graft (fourth type) was not yet being attempted. If the Thiersch graft did not result in a viable membrane, a prosthetic covering of the round window was utilized. During the latter period, in the absence of the stapes, "sound shadowing" of the round window with full thickness

Peritoneal graft in extremely retracted conjunctival sac.

VARIOUS mucosal and skin materials have been used in plastic operations on the conjunctiva, and the mucosa of the mouth and lips have been found most suitable. Apart from these materials, the Thiersch graft, part of the peritoneal membrane, the rectum, the preputium, and the labia minora have also been used for small conjunctival defects. Sorsby and Symons (1946) found amniotic membrane suitable in the reconstruction of large defects. Allen (1953) used autografts from the abdominal peritoneum. Malhotra (1957) recommended peritoneum, taken from inguinal hernias, as a routine procedure in entropion surgery. Erbakan (1958) successfully used a peritoneal graft taken from an inguinal hernia, in the case of a large naevus showing signs of malignancy, which was situated in the lower fornix and partly involved the bulbar conjunctiva. In the following three cases a peritoneal graft was used to enlarge the retracted conjunctival sac into which a prosthesis could not be inserted.

The Use of a Thiersch Graft for Covering the Fenestra and a Meatal Skin Flap for Isolation of the Pneumatic Cells and Tympanum in the Fenestration Operation

In a previous publication (1952) I dealt with some cases of fenestration in which I had used a Thiersch graft for covering the fenestra and a meatal skin flap for shutting off the pneumatic cells from the operative cavity. The use of a Thiersch graft aimed at obtaining a thin and bloodless fenestral covering, easy to invaginate and free from bone fragments and postoperative secretion. The pneumatic cells and the tympanum were isolated from the operative cavity with the purpose of obtaining a dry ear.As the consecutive cases operated on with a Thiersch graft now number 52 in which at least a year has passed since the operation, I have wished to compare them with about equally many consecutive cases operated on in the immediately preceding period by the technique of covering the fenestra with a tympanomeatal (Sourdille) flap, the technique being also in other respects uniform. The purpose of this comparison is to determine possible differences between the results obtained by the two operations. With this in...

“Intermediate” and “Full Thickness” Skin Grafting

Intermediate skin grafting was applied to two syndactylisms and one burn scar contracture of foot with success.This method have following advantages.1. Good attachment to the bed as well as Thiersch graft.2. Certainty of the fixation with suture in the proper place.3. Saving of movement of the skin even at the joint.But this method is far inferior to the full thickness skin grafting.

SOCKET RECONSTRUCTION

Some of the most distressing cases cosmetically are those in which a socket is so deformed that an artificial eye cannot be worn (fig. 1). Little of importance has been added to the technic of socket reconstruction since the publication of papers by J. F. S. Esser 1 and John M. Wheeler. 2 The purpose of this paper is to present some newer points in the technic which have proved satisfactory. For a discussion of the general technic of preparation of the socket the reader is referred to the article by John M. Wheeler published in 1921. 2b The preparation of the bed and the taking of the graft are fully described. The new developments are (1) the form around which the Thiersch graft is wrapped and (2) the method of handling the graft. The new form is concavoconvex (fig. 2) instead of biconvex, like that described by the two

USE OF RECONSTRUCTIVE SURGERY IN CERTAIN TYPES OF DEFORMITIES OF THE FACE

A large number of deformities, for correction of which reconstructive surgery is required, are seen primarily by laryngologists. Consequently, we are considering some applications of the principles of this type of surgery for certain types of deformities of the face that are of especial interest to laryngologists. There are certain general principles in reconstructive surgery that are the same whether applied to this field or to others. Some of these principles are applied in the making of a tubed flap, a delayed flap, a fullthickness skin graft or a Thiersch graft, or in the grafting of bone or cartilage. However, in operations about the face certain problems require additional consideration, owing to local anatomic, functional and cosmetic requirements. No field of surgery requires more careful preoperative study, exacting surgical technic, care in handling tissues, and close postoperative observation. Of the many deformities that occur about the face, we have selected

The Thiersch Graft. Its Preparation and Uses

The Thiersch Graft. Its Preparation and Uses

RECOVERY OF SENSATION IN DENERVATED PEDICLE AND FREE SKIN GRAFTS

The literature on the recovery of sensation in transplanted skin is extremely scanty. In 1899, Stransky1reported a few observations in eleven cases of pedicle flaps and Thiersch grafts in which he described a return of tactile sensibility as early as ten days after transplantation. Dubreuilh and Noel2made a few incomplete observations in eleven cases of Wolfe grafts, and found that superficial sensation recovered in about a year. Williams3described the presence of impaired sensation in a Thiersch graft thirty years after operation. Davis and Traut4made the brief statement that recovery of sensation begins at the periphery of all types of skin grafts in four or five weeks, and that tactile sensibility is restored first, followed by pain and temperature sense. Their method of testing and specific cases are not described. While recovery of sensation is not of major importance in the late results