Last Updated on 16 October 2007.

Harvesting Temporalis Fascia Graft
An Easy and time saving technique

Dr. Prahlada N.B
Karnataka ENT Hospital & Research Center
Opp. S.P Office, turuvanur Road, Kelagote,
Chitradurga - 577501,
Karnataka,
India.

Temporalis fascia is being used almost universally as a graft material for myringoplasty, tympanoplasty, mastoidectomy and many other procedures. Keeping the duration of surgery to the minimum in order to prevent infection and reduce the Operation theatre time and in turn cost of the surgery is very very important. As such obtaining a good temporalis fascia graft is an integral part of tympanomastoidectomy surgeries, this could be often time consuming procudere. Hereby I present an easy technique of obtaining temporalis fascia graft, which can be done in as less as 2 minutes.

Procedure

Step I : Skin Incision :
A post-auricular sulcus incision with 1 centimeter superior extension is made (Fig. 1). This extra 1 centimeter extension of the post auricular incision in obtaining a large graft. The ear is elevated forward, exposing the areolar tissue superficial to temporalis fascia and temporalis muscle.

Step II : Exposing Temporalis Fascia :
Now a self retaining mastoid retracted is applied sub-dermally in the incised wound and the blades are opened to expose the areolar tissue widely (Fig. 2).

Next lift the self retaining mastoid retractor away from the head, in order to lift the post-aural skin and areolar tissue away from the temporalis fascia. When this is done, there will be a dead space between temporalis fascia and areolar tissue . Take a small Spencer’s haemostat and probe the closed tip of the Haemostat into the areolar tissue obliquely and then open the arms (Fig. 3).

Then divide the areolar tissue between the opened arms of haemostat (Fig.4).

This directly exposes the temporalis fascia (Fig. 5).

Now reapply the self retaining retractor in the sub-areolar tissue plane. Use a periosteal elevator to separate the areolar tissue and expose the required amount of temporalis fascia. Next steps are same as you use routinely.

Step III: Obtaining Temporalis Fascia Graft:
I inject 3-4 cc of normal saline underneath the temporalis fascia and elevated it off from the temporalis muscle. Care is taken avoid injecting into the temporalis muscle. Make a small incision in the temporalis fascia at the periphery of proposed area selected for graft harvesting. The periosteal elevator is inserted through this incision beneath the temporalis fascia and the fascia is separated from the temporalis muscle. When one inserts the periosteal elevator beneath the fascia, the fascia should be thin that the elevator should be seen through the fascia.(Fig.6)

Next required amount of temporalis fascia is cut using a knife or scissors.

The graft is spread on a glass slide and any remnant muscle tissue is dissected off from the graft using a Periosteal elevator. Until used, the graft is kept covered with a gauze piece.

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Thulasi Charitable Medical Foundation (R) , Chitradurga - 577501, Karnataka, India