Before
starting the search, which was conducted at the Faculty of Medicine,
University of Damascus Bmhvy sympathy for a period of four consecutive
years, I will review a brief summary of what happened in the world in
this regard and for a period of not less than thirty years and we will
review tissues that have been used to create surfaces and slips in the
manufacturing of the eardrum and middle ear
Tissue of origin of epithelial ectoderm:
Use bait epidermal way Thiersch Tersh which has a thickness from 0.1 to 0.05 mm, which excised at the level of stratum germinativum
Minus thickness skin graft, which is equal to two thirds the thickness of the skin
Ren Rene taste in a way where it is after the eradication of the surface layer Thiersch any way you knock the dermis
Full thickness graft
And between the researchers have defects such grafts can be summarized as follows:
Form a secondary tumor Kolstrula
Contraction of the taste and small size
The presence of hair follicles in the graft and lead to Tosevat microscopic holes and enter the skin of the cavity
Altosevat and increase secretions from the skin graft due to poor nutrition and increased thickness due to malnutrition
This type of bait, a good education and in contact with a good side to side
The use of embryonic skin:
Roger used this method and used the skin as Converse embryos aged four months
Use of conjunctivitis:
Use Zollner Zollner conjunctivitis, but he abandoned this method because the conjunctiva containing fibers are flexible and shrink wrap around itself as it does not fit in a small Alanthagabat large
Albertawan use:
Use Birch Birch and trumpet Albertawan but proved to be Albertawan has several weaknesses, mainly the difficulty of obtaining bait Since mesothelioma mesothelium that constitute the face surface is composed of cells of fibrous fibrocytis cells and histiocytic histiocytis, which is known as any effect it leads to a scarring and adhesions large
The use of adipose tissue:
Use of fat in the process of patching small Lanthagabat by Goode Hill Goodhill and Ringenberg Ringenberg also used to Tseker of Kounkstd Alanthagabat occurring when lifting slide in manufacturing processes Passenger
The use of periosteal cartilage:
Used by many surgeons, such as Godhill often used periosteum or cartilage Alocdh pinna has met this kind of bait, good results by researchers
The use of periosteal bone:
Use of Fbl Portman and Wright Wright have been observed to resist severe, but he observed thickness in this taste and its ability to maximize hampered in some cases the vibration of the eardrum and preferably Portman eradication periosteum from beneath focal muscle, temporal, and not from the processus NA, where he was in the area of muscle, sleek and thin
The use of dura mater:
Used by Braprazhinska The inner surface is placed towards Alkhrashwm
Use of pericarditis Albericard:
Used by the trumpet Trombetto have noted that the viability of this taste for the rejection of a few
Use of the cornea:
Used in the operations of the cornea by patching Formann 1960 were used because they Do not have containers and can not be affected immunologically. The Flottes and Riu Alavoin 1963 time use and horny cow dried and frozen, but the experiments failed.
Use of amniotic membrane amnion:
Used by Farthlb, but he did not show the results of its use
Dual-use baits:
Skin with the soles of the cheek mucosa were used by Williams and Batiaykina in cases of hardening of the drum. Unterberger used fetal skin with mucous oral cavity, Kley used the skin with the peritoneum, the cartilage is also used with periosteum or cartilage butterfly ventilation tube through the course of the grafts used Trombetta vein with the external auditory canal skin
Intravenous use:
Used this method of time Volstein and Shea Shea and Tabb and Kramer Kramer and Goel Ford Guilford has been used in this way saphenous vein V Saphena magna has developed a lining of the vein intima to hand Alkhrashwm because they possess a smooth surface prevents the formation of adhesions with Alkhrashwm It also overspread attached to the mucosa quickly. Defects of this little taste of that supply may not cover the large Alanthagabat
The use of tympanic membrane paraffin heterosexual saved:
Used this method by Klein and longmir and Smith has noticed the success rate of 85% as to the method of preparation of the bait was done as follows: After the death of the person not later than 18 hours being incision behind the pinna and then made his top Hawiyah half cm then scalded skin reaches and raise Hawiyah with tympanic membrane separates the hammer and the anvil and the tensor tendon and cut chorda tympani nerve. Excised membrane with the grip of the hammer and part of the skin external auditory canal is then put the bait is taken in a solution of antibiotics for a period of 30 minutes and then placed onto the solution of paraffin sterile melted warm 40 degrees and then placed in the fridge and can be used for a period of two months after you save it, and that dissolving the wax liquid physiologic sterile with temperature of 40 degrees, and then placed a solution of antibiotics before use
Use of peritoneal muscle:
The most common bait has been used long ago by many times the Volastein and Babirila and House and Herman and others, and was perfect as it contains collagen fibers, flexible and metabolism of a good which leads to the growth of the epithelium on both sides of any skin from the brutal and mucous from ANSI, and with this growth, the peritoneum harbors in its thickness and leads to transfer vibration well, but that in some cases can get degeneration hyaline hyalinosis, leading to a scarring severe hampering of vibration good tympanic membrane, and as he gets shrunk in size taste of what is happening when the infiltration Levy and collagen, and that its growth is slow but strong and essential and leads to growth epithelium in both parties.
In the end we will sum up the way a new drum membrane which can be summarized in the following important points:
Phase I:
Called phase rotation Almsouri plasma and get in two days after placing the bait where the material is metabolized through the absorption of tissue fluids from the area which is located by the taste
Phase II:
Called the stage of re-education as it within 24 hours you can see the blood vessels in the old, but on the fifth day you get the new awareness of the truth
Phase III:
The construction phase, where the bait is formed between the subject and the region where the layer Guibrinih turn later to the granulation tissue and then cicatricial layer consists of a thin soft grows perhaps the epithelium and mucosa. The Alaltam are full during 4-6 weeks.
After studying this research through which we see that there is no one way to use baits, whether heterosexual or self-Because solid get nutrition in a way absorption, education and because it was the resistance and its ability to co-existence has decided to use in grafting tympanic membrane. Vasalbh composed of connective tissue collagen fibers have a fibrilla collagenica and a few elastic fibers, while the solid thickness ranging from 0.3 mm to 1.6 mm, a New Single in different areas and what is your name in the posterior pole, and pity as we head towards the equator of the eye for either of Lauaah Vasalbh have very few vessels and the inner surface does not have a vessel. Solid and does not shrink or get smaller in size when used as bait and a few anchoring immune and metabolism slow. All these factors led us to use it in patching operations. Used solid solution saved 0.5% of formol and preserved after sterilizing the containers and a private arbitrator and tests to deny Alnaah deficiency syndrome. Used this method on 35 patients ranged in age from 9-50 years, including 15 women and 20 males and 10 of them had a dual aspect and perforation were observed mostly in the period ranging from three years.
Method of surgery used:That most patients have the surgery conducted via external auditory canal and the number (25) patients in the following way:
After injection of adrenaline in Allidakayen and focal bone cartilage of external auditory canal was then Endoscopy edges of the perforation was conducted in a way Rosen incision top 0.5 to 1 cm distance Hawiyah and raised the slide was put pieces of bait Djilfum then put the infrastructure in the manner set out after the slide and then put a piece over Jelfom taste.
As for the patients who make them work hard behind the pinna surgeons, who was their number (10) has conducted the surgery as follows:
After injection of adrenaline has been extended an incision behind the pinna directly to the bone and then raise the periosteum and bone splitting external auditory canal and lifted the skin of tympanic membrane perforation and look at the edges and put the bait. Either way metadata infrastructure or when (4) patients had a perforation of the small diameter is not about 3 mm were carried out to them the following method:
After injection Allidakayen with adrenaline in focal bone cartilage has been theorizing edges of the perforation, then enter the bait through the edges of the perforation after placing a piece of Djilfum in the middle of the drum when one patient make his tumor Kolstrini of the attic after a pilgrimage attic was put bait directly without putting a piece of cartilage to manufacture the wall of the attic brutal withdrawal was observed postoperatively at half year
Audio tests:All patients who Khaddau of treatment they had a gap of air bone of 15-25 dB before treatment only one patient was to have a gap of 45 dB and he had a tumor Kolstrini in the attic improvement was observed in terms of audio post-operative patients who re their planning hearing and the number was 15 patients have been observed Tseker air bone gap completely in 10 patients at 5 and observed the amount of air bone gap of 10-15 dB was re-planning hearing postoperatively to 20 days.
Treatment after surgery:Aato patients and broad-spectrum antibiotics such as ampicillin and cephalosporins with anti-congestion for a period of 6 days postoperatively. At the 5 patients with dexamethasone Djilfum put under the bait and when the rest did not put any medication with Djilfum and the results were equal did not get rejected in any of the methods. Bench or Djilfum course is located under the riverbed was eradicated in the tenth day after surgery when an incision behind the pinna is decrypted pole was on the seventh day postoperatively.
Alnaúj and recommendations:There was no rejection of the taste at all patients who did have the surgery. Auditory test results postoperatively are all good, but when one patient has a perforation associated with auditory ossicles in the show. In a patient during the two years to the existence of perforation was observed as a result of infection and inflammation of the middle ear and sharp. The monitoring of 15 patients Haala patients during 3 years was observed by severe scarring and adhesions in one patient.
Recommendations:
Saved can be used for the manufacture of solid drum membrane
Prefer to use this method when there is a perforation can be restored through the course in order to provide the patient an additional surgical incision
Solid is very easy to use because the relative severity that help in the development of taste and not to their small size or shrinking
Use this method due to the ease and speed of the patient provides a long residence where one can make this method local anesthesia and the graduation of the patient directly and he does not need to lift pole or dressing or others, and thus ease the cost to the state and the hospital, the patient and surgeon.
Note:To the present day patients Asubho observers for a period of four years did not get any refusal or perforation but noted that the tympanic membrane with a relatively opaque color.
Tissue of origin of epithelial ectoderm:
Use bait epidermal way Thiersch Tersh which has a thickness from 0.1 to 0.05 mm, which excised at the level of stratum germinativum
Minus thickness skin graft, which is equal to two thirds the thickness of the skin
Ren Rene taste in a way where it is after the eradication of the surface layer Thiersch any way you knock the dermis
Full thickness graft
And between the researchers have defects such grafts can be summarized as follows:
Form a secondary tumor Kolstrula
Contraction of the taste and small size
The presence of hair follicles in the graft and lead to Tosevat microscopic holes and enter the skin of the cavity
Altosevat and increase secretions from the skin graft due to poor nutrition and increased thickness due to malnutrition
This type of bait, a good education and in contact with a good side to side
The use of embryonic skin:
Roger used this method and used the skin as Converse embryos aged four months
Use of conjunctivitis:
Use Zollner Zollner conjunctivitis, but he abandoned this method because the conjunctiva containing fibers are flexible and shrink wrap around itself as it does not fit in a small Alanthagabat large
Albertawan use:
Use Birch Birch and trumpet Albertawan but proved to be Albertawan has several weaknesses, mainly the difficulty of obtaining bait Since mesothelioma mesothelium that constitute the face surface is composed of cells of fibrous fibrocytis cells and histiocytic histiocytis, which is known as any effect it leads to a scarring and adhesions large
The use of adipose tissue:
Use of fat in the process of patching small Lanthagabat by Goode Hill Goodhill and Ringenberg Ringenberg also used to Tseker of Kounkstd Alanthagabat occurring when lifting slide in manufacturing processes Passenger
The use of periosteal cartilage:
Used by many surgeons, such as Godhill often used periosteum or cartilage Alocdh pinna has met this kind of bait, good results by researchers
The use of periosteal bone:
Use of Fbl Portman and Wright Wright have been observed to resist severe, but he observed thickness in this taste and its ability to maximize hampered in some cases the vibration of the eardrum and preferably Portman eradication periosteum from beneath focal muscle, temporal, and not from the processus NA, where he was in the area of muscle, sleek and thin
The use of dura mater:
Used by Braprazhinska The inner surface is placed towards Alkhrashwm
Use of pericarditis Albericard:
Used by the trumpet Trombetto have noted that the viability of this taste for the rejection of a few
Use of the cornea:
Used in the operations of the cornea by patching Formann 1960 were used because they Do not have containers and can not be affected immunologically. The Flottes and Riu Alavoin 1963 time use and horny cow dried and frozen, but the experiments failed.
Use of amniotic membrane amnion:
Used by Farthlb, but he did not show the results of its use
Dual-use baits:
Skin with the soles of the cheek mucosa were used by Williams and Batiaykina in cases of hardening of the drum. Unterberger used fetal skin with mucous oral cavity, Kley used the skin with the peritoneum, the cartilage is also used with periosteum or cartilage butterfly ventilation tube through the course of the grafts used Trombetta vein with the external auditory canal skin
Intravenous use:
Used this method of time Volstein and Shea Shea and Tabb and Kramer Kramer and Goel Ford Guilford has been used in this way saphenous vein V Saphena magna has developed a lining of the vein intima to hand Alkhrashwm because they possess a smooth surface prevents the formation of adhesions with Alkhrashwm It also overspread attached to the mucosa quickly. Defects of this little taste of that supply may not cover the large Alanthagabat
The use of tympanic membrane paraffin heterosexual saved:
Used this method by Klein and longmir and Smith has noticed the success rate of 85% as to the method of preparation of the bait was done as follows: After the death of the person not later than 18 hours being incision behind the pinna and then made his top Hawiyah half cm then scalded skin reaches and raise Hawiyah with tympanic membrane separates the hammer and the anvil and the tensor tendon and cut chorda tympani nerve. Excised membrane with the grip of the hammer and part of the skin external auditory canal is then put the bait is taken in a solution of antibiotics for a period of 30 minutes and then placed onto the solution of paraffin sterile melted warm 40 degrees and then placed in the fridge and can be used for a period of two months after you save it, and that dissolving the wax liquid physiologic sterile with temperature of 40 degrees, and then placed a solution of antibiotics before use
Use of peritoneal muscle:
The most common bait has been used long ago by many times the Volastein and Babirila and House and Herman and others, and was perfect as it contains collagen fibers, flexible and metabolism of a good which leads to the growth of the epithelium on both sides of any skin from the brutal and mucous from ANSI, and with this growth, the peritoneum harbors in its thickness and leads to transfer vibration well, but that in some cases can get degeneration hyaline hyalinosis, leading to a scarring severe hampering of vibration good tympanic membrane, and as he gets shrunk in size taste of what is happening when the infiltration Levy and collagen, and that its growth is slow but strong and essential and leads to growth epithelium in both parties.
In the end we will sum up the way a new drum membrane which can be summarized in the following important points:
Phase I:
Called phase rotation Almsouri plasma and get in two days after placing the bait where the material is metabolized through the absorption of tissue fluids from the area which is located by the taste
Phase II:
Called the stage of re-education as it within 24 hours you can see the blood vessels in the old, but on the fifth day you get the new awareness of the truth
Phase III:
The construction phase, where the bait is formed between the subject and the region where the layer Guibrinih turn later to the granulation tissue and then cicatricial layer consists of a thin soft grows perhaps the epithelium and mucosa. The Alaltam are full during 4-6 weeks.
After studying this research through which we see that there is no one way to use baits, whether heterosexual or self-Because solid get nutrition in a way absorption, education and because it was the resistance and its ability to co-existence has decided to use in grafting tympanic membrane. Vasalbh composed of connective tissue collagen fibers have a fibrilla collagenica and a few elastic fibers, while the solid thickness ranging from 0.3 mm to 1.6 mm, a New Single in different areas and what is your name in the posterior pole, and pity as we head towards the equator of the eye for either of Lauaah Vasalbh have very few vessels and the inner surface does not have a vessel. Solid and does not shrink or get smaller in size when used as bait and a few anchoring immune and metabolism slow. All these factors led us to use it in patching operations. Used solid solution saved 0.5% of formol and preserved after sterilizing the containers and a private arbitrator and tests to deny Alnaah deficiency syndrome. Used this method on 35 patients ranged in age from 9-50 years, including 15 women and 20 males and 10 of them had a dual aspect and perforation were observed mostly in the period ranging from three years.
Method of surgery used:That most patients have the surgery conducted via external auditory canal and the number (25) patients in the following way:
After injection of adrenaline in Allidakayen and focal bone cartilage of external auditory canal was then Endoscopy edges of the perforation was conducted in a way Rosen incision top 0.5 to 1 cm distance Hawiyah and raised the slide was put pieces of bait Djilfum then put the infrastructure in the manner set out after the slide and then put a piece over Jelfom taste.
As for the patients who make them work hard behind the pinna surgeons, who was their number (10) has conducted the surgery as follows:
After injection of adrenaline has been extended an incision behind the pinna directly to the bone and then raise the periosteum and bone splitting external auditory canal and lifted the skin of tympanic membrane perforation and look at the edges and put the bait. Either way metadata infrastructure or when (4) patients had a perforation of the small diameter is not about 3 mm were carried out to them the following method:
After injection Allidakayen with adrenaline in focal bone cartilage has been theorizing edges of the perforation, then enter the bait through the edges of the perforation after placing a piece of Djilfum in the middle of the drum when one patient make his tumor Kolstrini of the attic after a pilgrimage attic was put bait directly without putting a piece of cartilage to manufacture the wall of the attic brutal withdrawal was observed postoperatively at half year
Audio tests:All patients who Khaddau of treatment they had a gap of air bone of 15-25 dB before treatment only one patient was to have a gap of 45 dB and he had a tumor Kolstrini in the attic improvement was observed in terms of audio post-operative patients who re their planning hearing and the number was 15 patients have been observed Tseker air bone gap completely in 10 patients at 5 and observed the amount of air bone gap of 10-15 dB was re-planning hearing postoperatively to 20 days.
Treatment after surgery:Aato patients and broad-spectrum antibiotics such as ampicillin and cephalosporins with anti-congestion for a period of 6 days postoperatively. At the 5 patients with dexamethasone Djilfum put under the bait and when the rest did not put any medication with Djilfum and the results were equal did not get rejected in any of the methods. Bench or Djilfum course is located under the riverbed was eradicated in the tenth day after surgery when an incision behind the pinna is decrypted pole was on the seventh day postoperatively.
Alnaúj and recommendations:There was no rejection of the taste at all patients who did have the surgery. Auditory test results postoperatively are all good, but when one patient has a perforation associated with auditory ossicles in the show. In a patient during the two years to the existence of perforation was observed as a result of infection and inflammation of the middle ear and sharp. The monitoring of 15 patients Haala patients during 3 years was observed by severe scarring and adhesions in one patient.
Recommendations:
Saved can be used for the manufacture of solid drum membrane
Prefer to use this method when there is a perforation can be restored through the course in order to provide the patient an additional surgical incision
Solid is very easy to use because the relative severity that help in the development of taste and not to their small size or shrinking
Use this method due to the ease and speed of the patient provides a long residence where one can make this method local anesthesia and the graduation of the patient directly and he does not need to lift pole or dressing or others, and thus ease the cost to the state and the hospital, the patient and surgeon.
Note:To the present day patients Asubho observers for a period of four years did not get any refusal or perforation but noted that the tympanic membrane with a relatively opaque color.
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