Stacke’s method (Fig. 233). This consists of a large inferior flap, formed by making a longitudinal incision along the posterior upper border of the fibrous portion of the auditory canal and a transverse incision meeting it at right angles, the latter cutting through the fibrous portion of the meatus at its junction with the concha.
Fig. 233. Stacke’s Post-meatal Flap.
In order that these flaps may be thinner and more adaptable, the subcutaneous tissue should be cut away. Of these flaps the Y-shaped one is the most practicable, as it is suitable whether the posterior wound is closed or left open.
Körner’s method has the objection that there is subsequent disfigurement owing to the large meatal opening formed by cutting into the concha. It has the advantage, however, that the large posterior flap will cover the posterior surface of the wound cavity to a considerable extent, and also that it will permit a good view of the surface.
Panse’s flap is only of service if the posterior wound is left open and if there is not sufficient tissue left to make a posterior flap owing to previous destruction of the posterior wall of the auditory canal.
Stacke’s method is good if skin-grafting is afterwards employed.
CLOSURE OF THE WOUND
Excepting under the conditions mentioned below, the posterior wound is closed by bringing together the edges of the skin incision with fine silkworm-gut sutures ([Fig. 230]). Before this is done, the wound cavity should be irrigated with a weak solution of biniodide of mercury, dried, and the deeper parts of the wound plugged with a strip of gauze inserted through the external meatus. This will not only arrest the hæmorrhage and keep the inner part of the wound dry, but at the same time will keep the skin flaps in position. After the wound has been closed, firm pressure should be applied in front and behind the ear to press out any blood from the cavity.