Vascularized reconstruction of partial external auditory canal wall defects using the middle temporal artery flap.

OBJECTIVE

To review indications and surgical outcomes for partial canal wall defect reconstruction using the middle temporal artery (MTA) rotational flap.

STUDY

DESIGN

Retrospective review.

SETTING

Academic tertiary referral center.

PATIENT: Adults that underwent attempted reconstruction of various partial canal wall defects with the MTA flap by a single surgeon.

INTERVENTION(S): Review of demographic data, defect etiology and location, operative technique, subject wound healing risk factors, and time/success of canal wall healing.

MAIN OUTCOME MEASURE(S): Rate of complete canal wall healing/epithelialization by 8 weeks postoperation.

RESULTS

Eighteen cases were reviewed. Underlying canal wall pathology included the following: cholesteatoma, penetrating trauma, malignancy, osteonecrosis, and canal-mastoid fistula. In all cases, the canal wall was completely healed and epithelialized by 8 weeks postoperation, and there were no flap-related complications. Many cases (56%) involved previous intact-canal wall mastoidectomy surgery in the past with apparent degeneration of thinned canal wall bone. In 2 cases, the MTA pedicle had been violated by previous surgery; however, a smaller vascularized flap based on remnant blood supply was successfully used in each instance.

CONCLUSION

The MTA flap is useful as a thin, pliable flap that can be applied for reconstruction of various partial canal wall defects. This technique may be particularly useful in the settings of osteonecrosis and chronic infection where introduction of vascularized canal wall lining is particularly desirable. Although short-term outcomes are encouraging, the long-term outcomes of this technique are unknown.