Postauricular mastoid cutaneous fistula: a method of closure.

A postauricular mastoid cutaneous fistula may be a complication of chronic ear disease or ear surgery or both. Simple closure is often unsuccessful because of the necrotic skin edges, and it may result in a larger fistula. This paper illustrates a method of closing a large postauricular mastoid cutaneous fistula. The steps include excising the fistula, everting the mastoid epithelium toward the external auditory meatus, covering the undersurface of the everted skin edges with an anteriorly based periosteal flap, covering the flap with bone paté, placing a free graft of abdominal fat, and closing the defect with a rotational skin flap. This technique closes the fistula and obliterates the mastoid cavity.