The Hong Kong vascularized temporalis fascia flaps for optimal, mastoid cavity reconstruction

The classical modified radical mastoidectomy offers the advantages of combining the mastoid cavity, the attic and the external canal into one cavity that remains open for inspection. However the ultimate goal to predictably produce well healed, dry and safe mastoid cavities despite receiving much attention has not been fulfilled. By employing basic surgical principles of wide access to facilitate meticulous removal of all cholesteatoma and then eliminating all raw surfaces of the bony cavity with pedicled vascularized deep temporalis fascia, the Hong Kong Flap technique achieves the highest percentage of dry, stable, disease free ears. This living fibrous tissue layer provides the optimal substrate for epithelial resurfacing while separating the mucosa and bone of the middle ear and mastoid from the surface epithelium. Excellent healing even under unfavourable circumstances is ensured by the rich blood supply to the pedicled temporalis fascia flap. Furthermore the technique obviates the need for second look procedures in more than two-thirds of cases as the cavity lining becomes transparent and simple observation is safe. The Hong Kong Flap was used to reconstruct 107 cavities between October 1988 and October 1992. 86 were performed for primary cholesteatoma removal and 21 for revision of discharging cavities. 103 (96%) healed soundly. There were 4 dry perforations. Minor complications occurred in 8 (7%) patients. 84 (78%) required n+o second exploratory operation. This is a straight forward procedure requiring no special technical skills. The concept is rational and provides the ideal management for cholesteatoma by achieving a dry, safe ear with one operation.