Split Thickness Skin Grafting in Canal Wall Down Tympanomastoidectomy

Objective: To characterize the effects of a split thickness skin graft (STSG) on the healing of the mastoid cavity in patients undergoing canal wall down (CWD) procedures. Study Design: A prospective randomized study. Setting: Tertiary referral center. Patients: Twenty-four patients, ages 21 to 82 years, with a diagnosis of cholesteatoma, undergoing CWD tympanomastoidectomy for the first time. Intervention: Placement of a STSG to line the mastoid cavity at the time of surgery. Main Outcome Measures: The primary outcome was the amount of time required for epithelialization of the mastoid cavity. Secondary outcomes included postoperative complications, specifically, presence of otorrhea, granulation tissue, meatal stenosis, or tympanic membrane perforation. Results: Twenty-four patients met inclusion criteria. Thirteen patients were randomized to the study group and 11 patients to the control group. Data were collected at follow-up appointments scheduled at postoperative Weeks 3, 6, 9, and 12, as well as every 6 months thereafter. Average time for successful epithelialization of the cavity in the STSG group was 3.2 weeks. Average time for successful epithelialization of the control group was 6.6 weeks. Using a 1-sided 2 sample t test, this was found to be statistically significant with a p value of 0.000137. There was no significant difference in complications rates between the 2 groups. Conclusion: Placement of a STSG is a technique available to the otologist to facilitate rapid healing and epithelialization in patients undergoing CWD tympanomastoidectomy.