Fat Graft Myringoplasty
Considerations
Always review pre-op audiogram
Be sure the patient's goals and expectations align with the surgical plan
The size and location of the perforation
Dr. Rasgon has experienced success with large, even sub-total, perforations
Others also show that fat graft can work in medium to large perforations
2014: Influence of size and site of perforation on fat graft myringoplasty
However, many believe that fat is best only for "small" perforations of the pars tensa
2013: Fat myringoplasty outcome analysis with otoendoscopy: who is the suitable patient?
Preparation
Examine the post lobule fat, plan 1 cm incision
Infiltrate 1% Lidocaine with 1:100,000 Epinephrine
Procedure
Estimate the perforation size
Key: Freshen the edges well
Rosen or 5910 blade to postage stamp, small cups to remove
Excise the fat sharply, may contain dermis
Use the 15 blade to incise just the epidermis dermis and expose the superficial most fat
Turn the blade to undermine the skin in parallel with the dermis
Sharply excise a block of fat without tearing or shredding
Keep moist with a drop of saline
Pearl: The graft must remain intact (don't shred it)
Key: Floxin soaked Gelfoam in middle ear to support to graft, Floxin soaked paper patch laterally to sandwich the graft
Cut paper patch from the small finger, short enough to stay in the canal without being pulled out accidentally
Post-op
Key: Leave the paper patch totally untouched for the first 6 weeks and longer until it peels away on its own from the fat graft
Medications: No Floxin initially, but start 1 drop daily POD 7 until week 6
Clinic 1 week
Activity, for first 6 weeks:
Avoid nose blowing
When you sneeze or cough, do so with your mouth open
Do not fly in an airplane, swim, scuba dive, or play contact sports
Please do NOT allow any water into the ear canal - Use an ear plug or Vaseline coated cotton ball when showering
CPT code - 69620