Dimensional stability of free fascia grafts: clinical application

Abstract

Objectives/hypothesis: Animal experiments and human studies show that autologous fascia lata and temporal fascia change their dimensions during first 5 days of healing. Poor dimensional stability of the temporal fascia grafts may be responsible for the residual perforation sometimes seen in clinical practice.

Study design: Retrospective.

Methods: Tympanoplasties performed for large perforations or granular myringitis using either fascia lata or temporal fascia as graft material are included. The ears are divided into two groups. Group I includes ears with fascia lata, and group II includes ears with temporal fascia as graft material. Ears with minimum 1-year follow-up are included in the study.

Results: The results are studied in terms of 1) rate of primary closure of perforation, 2) rate of recurrent perforation, and 3) hearing improvement. It is noted that the ears with very large or subtotal perforations fared better (alpha = 0.05) in group I than similar ears in group II with respect to rate of primary closure of perforations. Similarly, ears in group I also have a lesser rate of recurrent perforation on long-term follow-up than ears in group II. No significant difference is noted in hearing improvement between the two groups.

Conclusion: Shrinkage of graft during healing phase appears to have significant relevance in the clinical situation. Ears having large perforations have high chances of residual perforations caused by limited margin of remnant tympanic membrane overlapping the graft. It seems logical to use fascia lata as graft material for large perforations because it has better dimensional stability.