A simplified technique for skin grafting the external ear canal

A SIMPLIFIED TECHNIQUE FOR SKIN GRAFTING THE EXTERNAL EAR CANAL SIMON C. PARISIER, MD, MICHAEL H. WEISS, MD

When performing surgery for canal atresia, stenosis, or tumors of the external canal, skin grafts promote rapid tissue healing in cases where there is deficient skin covering. Thin skin grafts, on the order of 0.001 in (0.25 rom), have prov.en very effective for providing a stable canal lining. 1 , 2 Thicker grafts are ineffective because their bulk narrows the canal lumen, and they produce an excessive amount of keratin debris. At the proper thickness, the graft is translucent and is composed of squamous skin going down to the rete layer. A thin split-thickness skin graft is difficult to manipulate because it curls and tends to bunch. Handling of the skin graft is made easier by gluing the graft on to thin silicone sheeting (0.001 in) with a benzoin-type adhesive. The resulting stiffened composite does not fold on itself and is easier to work with (see Figs 1 through 5). Additionally, the silicone sheeting helps in stenting the dermal surface of the skin graft against the underlying bone. Gelfoam (Upjohn Co, Kalamazoo, MI) is packed into the lumen and is left in position for 3 to 4 weeks, during which time the graft "takes." The silicone is then easily removed. Tympanic membrane defects are grafted with temporalis fascia; over which the split-thickness skin may be placed. The donor site is dressed with a thin sheet of Xeroform (Sterile Products, Valley Park, MD), with bandages over the Xeroform. These bandages are removed on the first postoperative day. The Xeroform is allowed to air dry and ultimately falls off by itself. Healing generally occurs within 10 days. The graft is so thin that we have even been able to take additional grafts of adequate quality from the same donor site to reconstruct a contralateral defect. Stents are not needed, and restenosis has been uncommon. The grafted skin is not as hardy as normal external canal skin and is prone to develop external otitis, particularly when exposed to moisture. For this reason we recommend long-term water protection with ear plugs. We do allow patients to swim 6 months after their procedure, but only with appropriate protection of the ear canal.

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FIGURE 1. A thin skin graft (0.25 mm) is harvested from the abdomen. The donor site is in an area that would be covered by a bikini-type bathing suit.

From The Department of Otolaryngology-Head and Neck Surgery, The Manhattan Eye, Ear, and Throat Hospital, New York, NY. Address reprint requests to Simon C. Parisier, MD, The Department of Otolaryngology-Head and Neck Surgery, The Manhattan Eye, Ear and Throat Hospital, 210 E 64th St, New York, NY 10021. Copyright © 1992 by W.8. Saunders Company 1043·1810/9210301·0011 $05.00/0

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OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY-HEAD AND NECK SURGERY, VOL 3, NO 1 (MAR), 1992: PP 58-60

FIGURE 2. (A) Thin silicone sheeting (0.001 in) is made taut by holding at the four corners with hemostats, because the application of the adhesive would otherwise cause it to curl. (B) The silicone is painted with tincture of benzoin. (C) The epidermal surface of the skin graft is glued to the silicone. The free dermal surface will be approximated to the bony surface.

FIGURE 3. (A) The silicone-skin graft composite is trimmed. (6) Slits are cut to allow the graft to conform to the surface of the tympanic membrane. (C) The graft is now shaped so that it will conform to external canal. PARISIER, WEISS

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FIGURE 4. (A) The silicone-skin graft is slid into the canal. (B) It may be secured with sutures and/or packing.

REFERENCES 1. Bellucci RJ, Converse JM: The problem of congenital auricular malformation. Trans Pa Acad Ophthalmol Otolaryngol 64:840, 1960 2. Jahrsdoerfer RA: Congenital atresia of the ear. Laryngoscope 88:1, 1978 (suppl 13)

FIGURE 5. The lateral aspect of the graft has been secured with sutures; the interior has been filled with absorbable packing.

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SKIN GRAFTING THE EXTERNAL EAR CANAL