Lyutenski Stefan, Schwab Burkard, Lenarz Thomas, Salcher Rolf, Majdani Omid
Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Eur Arch Otorhinolaryngol. 2016 Nov;273(11):3641-3646. doi: 10.1007/s00405-016-4005-6. Epub 2016 Mar 25.
The objective of the study was to examine the impact of the surgical wound closure technique as protection of the obliterated tympanomastoid cavity on the revision surgery rate after subtotal petrosectomy (SP). This is a retrospective case series conducted in a tertiary care referral center. 199 patients (212 ears) with recurrent chronic otitis media underwent SP followed by tympanomastoid obliteration with abdominal fat at a single tertiary referral center between 2005 and 2015. 124 SP were carried out without (group A), 74 with temporalis muscle flap (group B) and 14 with reinforcing material like polydioxanone foil or bovine pericardium or allogenic fascia lata (group C) for wound closure. The evaluated follow-up was either until the scheduled device implantation or 6 months postoperatively. We assessed the rate of postoperative wound healing disorder with revision surgery according to the surgical technique for closure of the obliterated cleft. Revision surgery due to impaired wound healing was necessary in 16 % of the total cases (group A: 18.5 %, group B: 10.8 %, group C: 21.4 %). Further analysis concerning the dehiscent area in both sites (retroauricular and blind sac of the external auditory canal) was conducted and discussed. There was no significant difference observed in the rate of revision surgery between the three groups. The wound healing process after SP is determined by many factors and cannot be significantly influenced solely by reinforcing tissue like the temporalis muscle flap or supporting materials.
本研究的目的是探讨乳突腔封闭术后手术伤口闭合技术对岩骨次全切除术（SP）后翻修手术率的影响。这是一项在三级医疗转诊中心进行的回顾性病例系列研究。2005年至2015年间，199例（212耳）复发性慢性中耳炎患者在单一三级转诊中心接受了SP手术，随后用腹部脂肪进行乳突腔封闭。124例SP手术未使用（A组）、74例使用颞肌瓣（B组）、14例使用聚二氧六环箔或牛心包或同种异体阔筋膜等加固材料（C组）进行伤口闭合。评估的随访时间为直至计划的装置植入或术后6个月。我们根据封闭乳突腔的手术技术评估了术后伤口愈合障碍及翻修手术率。在所有病例中，16%因伤口愈合受损需要进行翻修手术（A组：18.5%，B组：10.8%，C组：21.4%）。对耳后和外耳道盲袋两个部位的裂开面积进行了进一步分析和讨论。三组之间的翻修手术率没有显著差异。SP术后的伤口愈合过程由多种因素决定，不能仅通过颞肌瓣或支撑材料等加固组织受到显著影响。
