The button graft technique for perforations affecting less than 25% of the tympanic membrane: a non-randomised comparison of a new modification to cartilage tympanoplasty with underlay and overlay grafts
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Objectives: To evaluate a new composite cartilage—perichondrium graft (button graft) for repair of small-sized tympanic membrane perforations and to compare its success rate with that of the underlay and overlay techniques with temporal fascia or tragal perichondrium. Design: Prospective, sequential allocation of surgical technique study. Setting: Tertiary care university hospital. Patients: One hundred 95 patients aged 14-42 years with central, uncomplicated tympanic membrane perforations with completely visualised margins affecting less than 25% of the tympanic membrane, distributed in three groups: 1 (underlay), 2 (overlay) and 3 (button graft). Interventions: Patients were allocated in sequence to: 1 underlay graft, 2 overlay graft and 3 cartilage tympanoplasty with button graft technique. Patients were operated on under local anaesthesia. Main outcome measures: Postoperative status of the tympanic membrane, hearing improvement, duration of surgery and incidence of complications at 12 months postoperative.