Skin Grafts in Mastoid Cavities

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Although skin grafting of mastoid cavities is not a new procedure, it is only in recent years that improvement in technic and the advent of antibiotics have made it practical and widely accepted. Previously, failures were numerous and the end result disappointing. This paper is presented (1) to demonstrate a relatively simple technic which gives uniformly good results, (2) to illustrate the reduction in postoperative care, and (3) to determine the ultimate effect of skin grafts placed inside the mastoid cavity.

Skin grafting in mastoid defects was first advocated in this country by Mosher1 in 1911 (although it had been used as early as 1889 in Germany, where the procedure was both praised and condemned). Mosher's original technic advocated dissection of a crescent-shaped piece of skin from the posterior surface of the auricle, leaving it attached at the upper border of the postauricular sulcus. This pedicle flap, about ⅛ inch wide, was laid into the defect and the postauricular incision closed with drains inserted through the wound. In 1917 he revised this technic, using a free skin transplant applied to a paraffin basket mold made at the time of surgery. The mold and paraffin basket were removed on the fourth postoperative day through the external meatus.

In 1918, Kahn2 recommended Thiersch grafts which he applied through the meatus after closure of the postauricular wound. He created an ingenius instrument for this purpose. Later,3 he advocated a pedicle flap which he dissected from the posterior border of the postauricular incision.

Many. . .



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