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Teks Lengkap
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Introduction
Tympanoplasty grafting can be undertaken either with fresh, undried tissue or with graft material prepared to make it more rigid. Proponents of undried grafts argue that greater cellular survival facilitates the reparative process, with fibroblasts synthesising collagen.1 However, many surgeons use the more rigid, dried graft as they find it easier to manipulate; they argue that the graft simply forms a framework for epithelial migration.1 Two randomised, controlled trials comparing fresh versus dried grafts found that, while desiccation resulted in degeneration of cellular elements, there was no significant difference in tympanoplasty success rates.1,2 The recommendation was therefore that clinicians should opt for ease of manipulation.1
Tympanoplasty graft preparation methods vary. Some involve graft compression, such as between a vein press or tongue depressors clamped using towel clips.3 Other methods involve drying the graft with prolonged exposure to air, under a heater, under theatre lights or by using a hair dryer.3 Whilst these methods have been used successfully, they may put the graft at risk. The use of compression can risk tearing the graft if insufficient care is taken. Direct heat or prolonged air exposure poses a risk of excessive desiccation, and may increase exposure to airborne pathogens.
Technique
We report a novel technique for tympanoplasty graft preparation. After the graft is harvested, it is immersed in ear drops containing polyethylene glycol, flumetasone pivalate (0.02 per cent) and clioquinol (1 per cent) (Locorten-Vioform; Amdipharm, Basildon, UK). The graft stiffens and is typically removed after several minutes (Figure 1). The lead author utilises an underlay technique with a composite graft consisting of perichondrium, with an...