# Revision of blind sac and BAHA implant



## klp010102 (Aug 9, 2012)

Can someone give me some advice on this OP report please?

Tympanomastoid exploration with debridement of postauricular and mastoid
   wound infection.
2. Revision of blind sac closure of left external auditory canal.
3. Revision of left BAHA implant site.

INTRAOPERATIVE FINDINGS:
1. Subcutaneous postauricular wound abscess.
2. Apparent infected tympanomastoid obliterative fat graft.
3. Dehiscence of previous blind sac closure of external auditory canal.
4. Scar and soft tissue thickening adjacent to previously placed bone
   anchored hearing aid.

DESCRIPTION OF PROCEDURE:  The patient's old postauricular incision is
opened.  There is noted to be some immediate postauricular subcutaneous
granulation tissue, soft tissue necrosis, and purulent material.  This is
debrided.  The tympanomastoid cavity is explored.  Previously placed
obliteration soft tissue appears necrotic and infected.  This is
extensively debrided.  The surgical bed is then copiously irrigated with
dilute Betadine solution.  Thereafter the cavity is instilled with
Ciprofloxacin drops.

The old blind sac closure is amputated lateral to the site of prior
dehiscence.  This is further completely everted and closed meticulously
with multiple interrupted 3-0 Vicryl sutures.  The medial closure site is
then completely amputated such that no squamous epithelial content remains.
I the end there is nice obvious circumferential eversion of the blind sac
stump with watertight seal.

A limited L-shaped incision is made in the posterior-superior corner of the
BAHA implant bed.  Underlying soft tissue and scar is debulked.  There is
no evidence of infection.  This is closed with interrupted 4-0 Monocryl
sutures for the deep layer and a running 5-0 fast absorbing gut for the
skin.  Xeroform gauze and a healing cap are set as a bolster pressure
dressing to this area.  Xeroform gauze is likewise packed into the closed
external auditory meatus.

A flat Blake drain is placed into the tympanomastoid cavity and layered
closure is undertaken with multiple interrupted 3-0 and 2-0 Monocryl
sutures for the deep layers.  The skin is closed with a running 4-0 nylon.
A mastoid dressing is then applied.  The procedure is terminated and the
patient is transported from the room.


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