Traction Suture Tympanoplasty

Abstract

Subtotal tympanic membrane perforations are very common in Micronesia. The great distance between the islands, primitive conditions, and shortages of medical facilities and supplies must all be considered when a technique is designed for the closure of these perforations. Such a technique, using dissolvable sutures to position and support a medial temporalis fascia graft, is presented. A suture is used to place traction on the graft to assure proper placement under the anterior remnant or anterior canal wall skin. The graft is placed medial to the remnant but lateral to the malleus handle, which has been carefully dissected free of epithelium. Two hundred eighty-one cases were followed for' 6 months or more, with a success rate of slightly more than ninety-five percent. Complications of blunting, lateralization, reperforation of the graft, and cholesteatoma formation are discussed.