At our place we use fat in a bath plug fashion with fascia late over it and then tissue glue on that.
Also my doubt is regarding placement of the fascia lata should we place the muscle side of the graft towards the defect we are sealing or vice versa and why?
And What side of fascia lata do we keep towards the freshened margin of the perforation in tympanoplasty?
The simplest way is to repair duration simply and leave your patient 48 to 72 hours post operation in complete bed rest and insert your wound drain on positive pressure for only 24 hours; if it is needed. I do that with water seal repair or not.
This is what I do for my patients.
Some surgeons do the same, but put the patient's head down
Depends on the size of the bony defect as well as site of repair; for small defects in anterior skull base the bath plug technique (http://www.ncbi.nlm.nih.gov/m/pubmed/9472573/) works well. For larger defects, either septal/conchal/rib cartilage can be used as an underlay graft, with fascia (temporalis/Lata) or a Nasoseptal flap or middle turbinate mucosal flap as an overlay, followed by tissue glue and gel foam. The idea is to give a layered repair (http://www.ncbi.nlm.nih.gov/m/pubmed/25722926/).
we proseed the suture, use tissue glue and make a derivation just proximally to the lesion for 3 or 4 days
Can any one comment on the specific side on which the fascia lata needs to be placed ? As in muscle side of the fascia should face the defect or it can be placed vice versa too ?
Multiple alternatives for repair of the dura in case of a leak are available.
Other possibilities are using fibrin glue and/or covering the dura with an artificial one, which is application of a collagen sponge coated with human coagulation factors. They can be combined or used separately. These techniques are called is primary watertight repair, and the best treatment for this problem.
Also, flap techniques, in which they use muscle and omentum tissue.
However, this is nearly impossible to perform in case of an OPLL (ossified posterior longitudinal ligament) resection, because of the lack of space.
In this case, the intradural pressure can be decreased or the extradural pressure will be increased.
Most effective way is the first option (decrease of intradural pressure). Management of this process is medication and bed rest.
There is no standarization in the procedure of repairing a dural tear, but in this article you can find different methods of repair treatment of dural tears.
I hope this will help you out. Good luck!
http://www.ncbi.nlm.nih.gov.ololo.sci-hub.io/pubmed/28629679
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