gms | German Medical Science

Introduction: The technique for primary and revision mastoid (open) cavity reconstruction utilizing temporalis fascia (Hong Kong) flap is based on rational surgical principles. This simple surgery requires an additional 20 minutes of operating time and no extra/ costly equipment or consumables and yet consistently results in dry, self-cleaning cavities. The technique has been employed non-selectively in our service after primary and revision surgery with discharging cavities and in irradiated ears, lateral skull base, petrous apex, congenital atresia and cochlear implant surgery.

Method and Results: A consecutive series of 302 patients was analyzed for outcomes of the second or more surgeries, the time to achieve a dry ear and complications of the procedure.

Discussion: By covering all raw bony surfaces of the cavity with vascularized viable deep temporalis fascia, underlying bone and mucous membrane are separated from skin by the optimal foundation for epithelial coverage. Lining the mastoid instead of obliterating the cavity gives the surgeon the ability to observe disease recurrence and deal with it without the necessity of a second operating procedure. Cavities epithelialize quickly with few requiring a second exploratory operation as the lining becomes transparent and observation is safe.

Conclusion: A dry, safe ear the ultimate goal in cholesteatoma surgery can predictably be achieved with one operation by utilizing the sound principles of the Hong Kong Flap reconstruction technique.

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