On the fate of skin within the mastoid segment with an account of a new pedicle flap.

THE problem of healing in mastoid cavities is still with us despite many advances in knowledge and operative techniques. The optimal cavity should be small, completely lined by nourishing epithelium and accessible through an adequate meatus. The problem is as old as otology itself but it has received renewed impetus and urgency from the belated recognition that however successful tympanoplasty may be in dealing with the middle ear proper, it is doomed to failure unless it achieves a stable mastoid segment. It is not surprising, therefore, that there has been a revival of interest in various methods that have been devised from time to time for filling the mastoid cavity with viable inserts. Historically we can perhaps distinguish four stages: