Management of Post-Mastoidectomy Retroauricular Wound Dehiscence Using Advancement Flap: Case Report
DOI:
https://doi.org/10.59141/-.v8i1.505Keywords:
Mastoidectomy, Tympanoplasty, Wound dehiscence, Advancement flap, Skin graftingAbstract
Mastoidectomy with tympanoplasty commonly requires a postauricular incision and may be complicated by retroauricular wound dehiscence, particularly in the presence of infection, tissue tension, or impaired local perfusion. Persistent wound dehiscence can delay healing, compromise cosmetic outcomes, and necessitate secondary reconstructive procedures. Local advancement flaps and skin grafting are among the reconstructive options described. The purpose to report the clinical outcome of post-mastoidectomy retroauricular wound dehiscence managed using an advancement flap and review supporting evidence for this technique. Case report: A 52-year-old man with chronic suppurative otitis media with cholesteatoma underwent canal wall up mastoidectomy with tympanoplasty. During postoperative follow-up, retroauricular wound dehiscence complicated by local infection was identified. Surgical reconstruction was performed using a retroauricular advancement flap under general anesthesia. Postoperative follow-up demonstrated satisfactory wound closure, progressive epithelialization, and acceptable cosmetic outcomes, with no recurrence or major complications. Clinical question: Does advancement flap reconstruction offer better outcomes compared to skin grafting in post-mastoidectomy retroauricular wound dehiscence? Method: A literature search was conducted in PubMed, ScienceDirect, and Google Scholar to identify relevant studies on the management of post-mastoidectomy retroauricular wound dehiscence using advancement flaps or skin grafts. Seven relevant articles were identified. Case reports and small case series demonstrated high primary wound closure rates and low recurrence following advancement flap reconstruction. Skin grafting facilitated epithelialization in selected cases but showed variable outcomes in compromised wound beds. Advancement flap reconstruction is an effective and reliable option for managing retroauricular wound dehiscence following mastoidectomy, particularly in chronic or infected wounds.
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Cerci, F. B. (2016). Staged retroauricular flap for helical reconstruction after Mohs micrographic surgery. Anais Brasileiros de Dermatologia, 91(5 Suppl. 1), 144–147. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0365-05962016001100144&lng=en&tlng=en
Curzio, M., Macchini, V., Di Lella, G., Massaro, A., & Sonego, G. (2023). Reconstruction of retroauricolar surgical defect using the “Jigsaw puzzle” advancement flap. Dermatology Reports. https://www.pagepress.org/journals/index.php/dr/article/view/9724
Gulsen, S., & Baltacı, A. (2021). Comparison of endoscopic transcanal and microscopic approach in type 1 tympanoplasty. Brazilian Journal of Otorhinolaryngology, 87(2), 157–163. https://linkinghub.elsevier.com/retrieve/pii/S1808869419300904
Hochwalt, P. C., Christensen, K. N., Cantwell, S. R., Hocker, T. L., Brewer, J. D., Baum, C. L., Arpey, C. J., Otley, C. C., & Roenigk, R. K. (2015). Comparison of full-thickness skin grafts versus second-intention healing for Mohs defects of the helix. Dermatologic Surgery, 41(1), 69–77. https://doi.org/10.1097/DSS.0000000000000208
Kennedy, K. L., & Lin, J. W. (2025). Mastoidectomy. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/pubmed/17097435
Khatri, R. P. (2021). A case study of post-auricular persistent mastoid cutaneous fistula closure by anteriorly based temporalis muscle flap and tempero-mastoid fascio-cutaneous-periosteal flap. International Journal of Otorhinolaryngology and Head and Neck Surgery, 7(9), 1551. https://doi.org/10.18203/issn.2454-5929.ijohns20213298
Moras, K., Bhat, M., Lasrado, S., Jayakumar, C., & Pinto, G. (2014). Postaural incision closure in single layer versus multiple layers: A comparison. Indian Journal of Otology, 20(2), 60. http://www.indianjotol.org/text.asp?2014/20/2/60/131868
Olusesi, A. D., & Opaluwah, E. (2014). Postauricular advancement fascio-cutaneo-periosteal flap for closure of mastoid cutaneous fistula. Otolaryngologia Polska, 68(5), 276–280. https://doi.org/10.1016/j.otpol.2014.02.001
Papa, G., Stocco, C., & Arnež, Z. M. (2020). Middle-retroauricular island flap: A new axial flap for reconstruction of non-helical ear defects. Plastic and Reconstructive Surgery – Global Open, 8(11), e3207. https://journals.lww.com/10.1097/GOX.0000000000003207
Pendolino, A. L., Pavone, C., & Zanoletti, E. (2019). Fibro-muscular-periosteal flap and bilobed flap for post-auricular cutaneous mastoid fistula closure. The Journal of Laryngology & Otology, 133(8), 723–726. https://www.cambridge.org/core/product/identifier/S0022215119001063/type/journal_article
Primadina, N., Basori, A., & Perdanakusuma, D. S. (2019). Proses penyembuhan luka ditinjau dari aspek mekanisme seluler dan molekuler. Qanun Medika: Medical Journal of Faculty of Medicine Muhammadiyah Surabaya, 3(1), 31. http://journal.um-surabaya.ac.id/index.php/qanunmedika/article/view/2198
Prohaska, J., & Cook, C. (2025). Skin grafting (archived). StatPearls Publishing. http://www.ncbi.nlm.nih.gov/pubmed/16042930
Ramsey, M. L., Walker, B., Marietta, M., & Patel, B. C. (2025). Full-thickness skin grafts. In Operative Dictations in Plastic and Reconstructive Surgery (pp. 199–201). StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532875/
Restuti, R. D., Sriyana, A. A., Priyono, H., & Saleh, R. R. (2021). Postauricular cutaneous mastoid fistula closure with combination of bilobed flap and fibro-muscular-periosteal flap. Indian Journal of Otology, 27(2), 116–119. https://journals.lww.com/10.4103/indianjotol.indianjotol_10_21
Saki, N., Araghi, S., Abshirini, H., & Nikakhlagh, S. (2015). Postauricular advancement flap for closure of persistent mastoid cutaneous fistula. Biomedical and Pharmacology Journal, 8(October Special Edition), 795–797. https://doi.org/10.13005/bpj/785
Seth, I., Lim, B., Cevik, J., Gracias, D., Chua, M., Kenney, P. S., Rozen, W. M., & Cuomo, R. (2024). Impact of nutrition on skin wound healing and aesthetic outcomes: A comprehensive narrative review. JPRAS Open, 39, 291–302.
Shinnawi, S., Gordin, A., Zaroura, I., Rafoul, B., Khoury, M., & Cohen‐Vaizer, M. (2022). No difference in wound complications with or without a post‐operative pressure dressing: Our experience in 135 children undergoing mastoidectomy. Clinical Otolaryngology, 47(5), 594–598. https://onlinelibrary.wiley.com/doi/10.1111/coa.13947
Tsitsiou, Y., Mantelakis, A., & Joshi, A. (2020). Use of a sternocleidomastoid rotational and cervical-fascial advancement flap for closure of a persistent mastoid cutaneous fistula. The Journal of Laryngology & Otology, 134(10), 936–938. https://doi.org/10.1017/S0022215120001498
Tsuladze, A., & Nakhutsrishvili, I. (2025). Surgical management of a rare complication of mastoidectomy: A retroauricular cutaneous-mastoid fistula. Cureus. https://doi.org/10.7759/cureus.84030
Wetmore, S. J., Bueller, H. A., & Cost, J. L. (2014). Split thickness skin grafting in canal wall down tympanomastoidectomy. Otology & Neurotology, 35(1), 97–100. https://doi.org/10.1097/MAO.0b013e3182a4445d
Zhang, Y. Z., Li, Y. L., Yang, C., Fang, S., Fan, H., & Xing, X. (2016). Reconstruction of the postauricular defects using retroauricular artery perforator-based island flaps. Medicine, 95(37), e4853. https://journals.lww.com/00005792-201609130-00048
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