Use of Alloderm in the neurotologic setting

PURPOSE: To determine whether Alloderm (Life Cell Corporation, The Woodlands, TX) can be used to cover canal wall down mastoid defects, as well as repair dural defects from translabyrinthine and transpetrosal approaches to the skull base. METHODS: A retrospective analysis was performed at an academic tertiary care medical center. Eighteen patients were operated on with canal wall down mastoidectomies, and Alloderm was used to reconstruct the tympanic membrane and line the mastoid cavity. Eleven patients had dural defects reconstructed after skull base approach surgery. We wanted to determine whether the Alloderm graft healed in canal wall down mastoidectomy procedures with good epithelialization. For the skull base approaches, we determined whether a cerebrospinal fluid leak had occurred. RESULTS: The 18 patients who were reconstructed with an Alloderm graft after a canal wall down mastoidectomy all had good epithelialization. As with fascia reconstruction, some granulation tissue occurred, but this was easily controlled in the office setting. Of the 11 patients who underwent reconstruction for skull base surgery approaches, none developed a cerebrospinal fluid leak. CONCLUSION: Alloderm may provide a suitable grafting material when fascia is either not readily available, or the size of the defect precludes the use of fascia.