Replacement of Canal Skin

The canal skin is trimmed of any irregular edges and is replaced over the bony canal (Fig. 4—5). Medially it is positioned to overlap the fascia graft by 1 to 2 mm, which helps promote epithelialization of the drum and prevent anterior blunting. It is important to ensure that no edges of the skin remain rolled under, because small epithelial cysts may develop. The canal is now packed firmly with Gelfoam. The first piece of packing is a cigar-shaped, tightly rolled piece of Gelfoam that is placed in the anterior sulcus to give definition to the angle. The posterior aspect of the canal is not fully packed to leave room for the vascular strip.

FIGURE 4—4 Rehydrated fascia is placed under the malleus handle and on outer surface of remnant.

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