Mastoidectomy reconstruction: revascularizing the canal wall repair.

Blood supply is the key to reconstruction of canal wall defects in cases of prior radical mastoidectomy. Revascularization of the defect is essential to nourish the overlying canal skin and to protect and supply the underlying solid support layer. Prior techniques have relied on free grafts or on local flaps of suspect vascular adequacy. A temporal pericranial flap is described that introduces a vascular bundle directly into the canal wall defect site. The flap is based on the superior and posterior aspects of the pinna and contains the middle temporal artery, which provides axial supply to the flap tip. The tissues of the flap are compact, enabling easy handling in the confines of the new canal. The flap is turned medially into the canal, avoiding compression or kinking of the vascular axis. The technique has been used in over 60 cases, producing excellent clinical results from a simplified technique.