The use of Davis pinch grafts to promote epithelialization in a post- mastoidectomy cavity

Otorrhoea following open mastoid cavity surgery is common and is estimated to occur in 10 to 35% of patients. It is usually due to failure of epithelialisation of the mastoid cavity for a variety of reasons. Even in the ideal cavity, which is small with a low facial ridge and large meatus, 10% discharge recurrently. Various techniques designed to promote epithelialisation have been proposed including cavity revision with or without a meatoplasty, cavity obliteration by different methods and partial or total reconstruction of the cavity. No single technique has proved superior. Other approaches that directly address the problem of epithelialisation have been used, including partial thickness skin grafting, autologous and indeed synthetic epidermal cell grafting, with varying degrees of success. We describe the Davis pinch graft technique, as devised by Holsted and popularized by Davis for venous ulcers. Free pinch grafts consisting of epidermis and small amounts of dermis are taken from the anterior abdominal wall and inserted into the revised mastoid cavity. We present a retrospective study of 15 patients who underwent revision mastoidectomy and Davis pinch grafting for persistent ottorrhoea, and discuss the results with respect to patient symptomatology and the surgeons assessment of the cavity. In conclusion, we believe that the Davis pinch graft has a proven beneficial effect in the management of post-mastoidectomy otorrhoea.