A central or marginal perforation of the eardrum can be closed by placing a small piece of vein graft beneath the perforation in the middle ear and encouraging the epithelium of the drum to proliferate over it.
I discovered this technique while doing a fenestration of the oval window operation in which the drum was accidently torn at the margin while elevating it from its sulcus. A triangular marginal defect resulted with its base on the annulus, about one-tenth the area of the drum. This was in the postero-inferior quadrant of the drum where such perforations are prone to occur during the elevation of the flap. After completing the operation I reapproximated the edges of the defect as completely as possible. I then put a small piece of vein graft just beneath the perforation, the intima toward the middle ear and the adventitia in contact with the undersurface of the
SHEA JJ. Vein Graft Closure of Eardrum Perforations. Arch Otolaryngol. 1960;72(4):445–447. doi:10.1001/archotol.1960.00740010455003
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