Fibro-muscular-periosteal flap and bilobed flap for post-auricular cutaneous mastoid fistula closure

Background A post-auricular cutaneous mastoid fistula is a rare condition that can occur following radical mastoid surgery, chronic suppurative otitis media or spontaneous exteriorisation of cholesteatoma from the mastoid through the post-auricular skin surface. Management of a post-auricular cutaneous mastoid fistula can be challenging for the surgeon.Objective This paper describes a surgical refinement for post-auricular cutaneous mastoid fistula closure, involving a fibro-muscular-periosteal flap to cover the mastoid cavity, combined with a bilobed flap from the mastoid and lateral neck regions for skin closure.Method and results A case of a post-auricular cutaneous mastoid fistula developed after revision tympanoplasty for a cholesteatoma. The condition was successfully treated with the presented technique. Pre- and post-operative photographs are provided for demonstration.Conclusion The fibro-muscular-periosteal flap combined with a bilobed flap from the mastoid and lateral neck regions, in our view, can be considered a valid option for post-auricular cutaneous mastoid fistula closure.