Skin Grafting in Otology

Abstract

Proper healing after surgery of the external auditory canal and open-cavity mastoid depend on epithelialization of exposed surfaces. This may be retarded by the formation of abundant granulation tissue or cicatrix, which can be dealt with by the use of thin, split-thickness skin grafts. This technique, which has received little attention in the literature, is described in detail and nine cases treated for various disorders are illustrated. Patient ages ranged from 5 to 80 years and the mean follow-up was 17.2 years. Results, complications, and caveats for successful grafting are presented.

Auricular Split‐Thickness Skin Graft for Ear Canal Coverage

“…STSG reconstruction of the EAC has been evaluated in several case series, most of which have demonstrated low rates of restenosis in small series. 4,5 While acute postoperative edema/granulation or mucosalization from STSG from SPAA is possible, no patients in our series developed prolonged postoperative EAC stenosis or bony exposure. The STSG used in EAC reconstruction needs to be thin to ensure improved take and to decrease the risk of stenosis, which is why we aim for the grafts to be thinner than the blade.…”

“…This appears to be a reasonable alternative to an extremity donor site, which requires the intraoperative preparation of an alternate site and can lead to a more visible scar. STSG reconstruction of the EAC has been evaluated in several case series, most of which have demonstrated low rates of restenosis in small series 4,5 . While acute postoperative edema/granulation or mucosalization from STSG from SPAA is possible, no patients in our series developed prolonged postoperative EAC stenosis or bony exposure.…”

A Novel Topical Treatment for Keratosis Obturans

“…Skin grafts do not possess the unique migration pathway the external auditory ear canal epithelium normally exhibits. Skin grafts are unable to restore normal migratory pathways of the ear canal and therefore periodic microscopic cleaning remains mandatory (15). After canaloplasty complete re-epithelialization takes approximately 6.7 weeks.…”

Split-Thickness Skin Graft Attachment to Bone Lacking Periosteum

“…[1][2][3][4] A study by Stallings et al 5 of skin grafting over bare bone in rabbits showed only a 22% graft take compared with 77% for skin grafting over periosteum. Nevertheless, skin grafts have been applied to head and neck soft tissue defects with bare bone in a variety of situations: coverage of canal wall or mastoid bone in otologic surgery, [6][7][8] lining of the orbital wall after exenteration, 9,10 repair of total scalp defects with exposed calvarium, 11,12 and reconstruction of composite resection defects with exposed mandible. 13 However, some authors advocate delayed skin grafting in such situations to allow the development of a vascularized recipient site with granulation tissue.…”

“…13 However, some authors advocate delayed skin grafting in such situations to allow the development of a vascularized recipient site with granulation tissue. 7,11,12 Clinical evidence suggests that skin grafting on bare bone is feasible, although many surgeons remain skeptical. Such a technique is important in head and neck reconstruction (1) to facilitate more rapid wound healing and to decrease the incidence of infection in the case of an open defect; (2) to provide coverage of large defects that cannot be closed primarily, especially while awaiting oncologic margins; (3) to allow surveillance in defects with a high propensity for recurrence; and (4) to eliminate the need for additional procedures and/or dressing changes while awaiting the development of a granulation bed.…”