We investigate the feasibility of using laser tissue welding technology for the forming of the transcanal underlay drum chamber. We used 10 bones from human bodies. After manufacturing the perforation under the drum membrane, we introduced the harvested membrane through the perforation, and used laser tissue welding to fix the membrane graft in place in the underlying way. The procedure is performed by transcanal method and no middle ear packaging is required. Immediately after the graft was placed, we tested its integrity qualitatively with a blunt probe. In all 10 cases, the graft was as strong as the drum membrane. Conclusion: laser penetration imaging of the drum chamber is a feasible and effective method for repairing the drum membrane. The ultimate goal is to develop a technology that allows doctors to routinely perform lower drum chamber forming for medium-sized piercings in office settings. Two basic procedures for repairing the large perforation of the drum membrane are Coverage technology and padding technology. Cover technology requirements resection tear ducts anterior wall skin and tympanic membrane skin; Usually reserved for large piercings involving the front of the drum membrane. Underlay technology requires the creation of the atympanomatal flap in order to place the graft under the natural drum membrane; It is usually used for smaller, post-based piercings. The overall success rate of these programs is the same. (1) However, both operations have their drawbacks: * canal and/or rear ear incision are required in order to obtain a perforation. * Middle ear packaging is usually used to support a fascia transplant, sometimes resulting in hearing loss shortly after surgery. * Because the operation is performed in the operating room with the patient under general anesthesia, it is expensive and has complications from general anesthesia. While small piercings can be treated in the office with confetti or fat grafts, these techniques are not even suitable for medium-sized piercings. A technique that allows for medium-sized perforated transcanal drum chamber forming in an office environment under local anesthesia will greatly reduce the incidence of patients and the cost of this common ear surgery. Laser Tissue Welding Technology laser welding is a new technology to weld the tissue together. Asolid- Laser Diode (808 nm) Used to activate a protein Base welding combined with laserenergy-absorbing dye( Green). In order to absorb the output wavelength of thelaser, the dye color is specially selected. When the surrounding tissue remains the same, the weld is first heated and activated (figure 1). (2-4) This technique has been applied in experiments and clinical practice, and has achieved good results in the anastomosis of blood vessels, intestines, urethra and trachea. (5-9)[ Figure 1 slightly] The main advantage of laser welding is that the tissue can be combined in areas that are not accessible by traditional techniques such as stitching. (10) One of the authors uses laser welding (D. E) Repair body spinal dural and rats spinal dural incision. (11) It was found that the leakage pressure of the hard spine film was significantly higher than that of the conventional suture closure. Histological studies of the brain of potential rats show that there is little heat dissipation in the surrounding tissues. Long- Term histological study of laser Welded Dura exposed a wellIncision healing. (11) This experience paved the way for clinical trials of in-house closure in ongoing laser tissue welding operations. The purpose of this study is to explore the feasibility of transcanalunderlay drum chamber forming with laser welding technology. Methods laser welding with diode laser module ( Medical devices; Mountain View, California. ) Fiber optic cable with quartz Silicon (600-[micro]M core diameter). The laser parameters are as follows: Power, 0. 5 W; Pulse duration, 0. 5 sec; And pulse interval, 0. 1 sec. The power density is 15. 9 W/[cm. sup. 2] Fluency is 8. 0J/[cm. sup. 2]per pulse. The main wavelength output of the diode laser is 808 [+ or -]1 nm. Additional laser energy bands appear in the visible spectrum so that the operator can visualize the spot size of thelaser during activation. Laser welding is fresh before each experiment runs. Pasteurized 25% human protein solution ( Melville Department of Biological Products, New York Blood Center; New York City) Freeze-dried (dehydrated) Conditions for understanding the form of powder (2. 5 g of albumin) And in 6. Sterile water of 0 ML ( 42% clear protein solution). Filter through a 0 after sterilization. 2-[micro] M hole filters, 200-[micro] An equal sample of the solution is mixed with 100 [micro] L sterile rice sunflower alkali (CardioGreen, 2. 5 mg/ml; Picton, Dixon and Co. ; Medical doctor kokissville)and stored at -20[degrees]C. Twenty- Thaw The Solution 4 hours before use and with 200 UL sodium glass ( Hilon, 10 mg/ml; Kabi pharmaceutical eye medicine; In Monrovia, California. ) Make the total volume 0. 5 ml/aliquot. The final solution is rotated for 30 seconds and stored overnight in the cone tube. The bones of ten human bodies are caught in a house. Bone Stent ( Ear Hospital; Los Angeles). The drum membrane was observed with a wild operating microscope. A subcomplete perforation of at least 50% of tensa was made with an anesthetic sickle knife. Pay attention to ensure that some drum membranes remain around the perforation. Completely remove the middle drum membrane. Remove cartilage cells from the cerebral cortex and prepare to approach 125% of the area of the membrane perforation. The membrane is introduced by perforation, so that half of the graft protrudes under the residual membrane. Welding is 1- Ml syringe and 16-Angiocath (figure 2, A). Then activate the welding with laser. This fixes the first half of the graft to the lower surface of the drum membrane. The remaining graft is then placed under the remaining perforation and welded in place. This creates a strong structural bond between the graft and the lower surface of the drum membrane (figure 2, B). [ Figure 2: The integrity of the weld was qualitatively tested by increasing pressure gradually on the side of the graft until the graft was completely removed from the drum membrane. As a result, the Transcanal underlay drum chamber forming can be easily carried out with thelaser tissue welding technology. The adhesion of the graft to the natural drum membrane is very strong. In order to break through the graft, a large amount of side pressure needs to be applied with a blunt probe. In 8 cases, the surrounding drum membrane breaks under pressure before the laserWeld seal broken. No obvious thermal damage was found in the underlying middle ear structure or around the drum membrane. This study confirmed the technical feasibility of using laser tissue welding technology for drum chamber plastic surgery. The ultimate goal is to develop a technology that allows doctors to perform a toperform underlay drum chamber forming of medium-sized piercings in an office environment. Further research is needed before this becomes a reality, including long-term research Test the long-term animal study of the effects of thelaser and solder on drum membrane healing. Laser welding has a reliable clinical safety record. During the survival of the hard spine membrane, there was no damage to the subcortex of the brain. Therefore, it is believed that laser welding is also safe in the middle of the ear. The thermal effect on the intermediate structure was not noted in our study. All components of the lasersoldder mixture have proven clinical safety records. (12,13) Albumin is commonly used as an intravenous expansion agent. Indocyanine green is clinically used as an eye angiography dye. (14) Other organizations are at greater risk of bonding technology. (15) For example, Ju C (e. g. , Krazy Glue) Can produce strong soft Tissue response, therefore, is not suitable for this operation. In addition, the tensile strength of the fiber protein glue is much lower than that of the laser welded mixture and has the potential for allergic reactions. (16,17) In our study, we used the flap of the mastoid bone cortex as a graft material. Of course, this is not a suitable or ideal donation material in a clinical office environment. The superficial fascia can be used, but this requires a separate incision and anatomy, which will increase the complexity of the operation and the discomfort and general incidence of the patient. Other possible graft materials include the same graft, the same graft (animal fascia),and man-Make substances. Laser welding drum chamber forming is best performed under local anesthesia in the form of applying phenol on the drum membrane. If additional anesthesia is required, 1% licain can be placed in the middle ear to anesthesia the middle ear mucosa. For cases where it may be necessary to extend the operating time, it is easy to infiltrate the external tube of the medicinal licain. If the edge of the perforation needs local cleaning, it needs to be out of anesthesia. Overall, the process takes more time than regular cuts and tube inserts in the office. The taboos of surgery include suspected Gallbladder tumor, ear secretions, bone canal problems or marginal perforation. Formal Public procedures are still shown in these cases. References (1. )Rizer FM. Covered with the underlying drum chamber. Part 1: A historical review of the literature. 1997; 107(suppl 84):1-25. (2. ) Murray LW, Su L, Kopchok GE, White RA. Cross-linking of extracellular matrix proteins: preliminary report on possible mechanisms of laser welding. Laser of 1989 kilometers; 9:490-6. (3. ) White RA, Kopchok GE, Donayre CE, etc. Organization fusion mechanism in Ar laserwelded vein- Arterial anastomosis Laser irradiation; 8:83-9. (4. ) Bass LS, Moazami N, Pocsidio J, etc. Laser welding below variable type Icollagen. Laser of 1992 kilometers; 12:500-5. (5. ) Oz MC, Bass LS, Mr. Williams and others. Preliminary clinical experience of laser Auxiliary welding of human vascular tissue. In: tan O of White RA. White JV, eds. Laser in dermatology and tissue welding. Wash Bellingham. International Society of Optical Engineering, 1991. (6. ) Libutti SK, Oz MC, Forde KA, etc. Staining enhances colon anastomosis in dogs Enhanced fiber-protein source and diode laser. Hogg ensk 1990; 4:97-9. (7. ) Kirsch AJ, Miller ML, hensil TW, etc. Laser Tissue Welding in Urethra Reconstruction: First human experience. Urology 1995; 46:261-6. (8. ) Auteri JS, Jeevanandam V, Oz MC, etc. The use of docyanine green dye to enhance the fiber protein in the trachea Infrared diode laser. In: Joffe SN, eds of Atsumi K. Laser surgery: advanced representation, treatment and System II. Wash Bellingham. : International Society of Optical Engineering, 1990(9. ) Kirsch AJ, Chang DT, Kayton ML, etc. Transplant the urethra using a diode laser and welded seamless rabbit bladder mucosa patch. JUrol 1995; 153:1303-7. (10. ) Short Jia, renesh L, Ossoff RH. Prevent swallow skin fistula with laserWelding technology. 1995; 105:717-22. (11. ) Foyt D, Johnson JP, Kirsch AJ, etc. The Laser Tissue Welding hard spine film is closed. 1996; 115:513-18. (12. ) Kirsch AJ, Chang DT, Kayton ML, etc. Effect of diode laser welding with dye Urology commonly used suture tensile strength enhancement glue. Laser of 1996 kilometers; 18:167-70. (13. ) Richter AW, Ryde EM, Zetterstrom EO. Non- The immune activity of sodium hyaluronic acid preparation in the human body. Int Arch anti-allergic ApplImmunol 1979; 59:45-8. (14. ) Obana A, Miki T, Hayashi K, etc. Investigation of complications of docyanine green angiography in Japan. J Ophthalmol 1994 in the morning; 118:749-53. (15. ) Bird sea DM, O\'Grady K. Surgical Tissue Adhesive for ENT Head and Neck Surgery Am1994, north of Ot linguole; 27:203-9. (16. ) Mitsuhata H, Horiguchi Y, Saitoh J, etc. Allergic reaction of local fiberglass glue. Anesthesia 1994; 81:1074-7. (17. ) Berguer R, Staerkel RL, Moore EE, etc. Warning: the use of fibroprotein glue in deep liver wounds can cause fat reactions. Case reports. J Trauma 1991; 31:408-11. David Foyt, MD; William H. Slytheri III, Maryland; Matthew J. Carfrae, MD from the northeast Ear Institute in Albany, New YorkY. (Dr. Foyt) House Ear Institute in Los Angeles (Dr. Slattery) Division of Labor ofotolarynology, Albany Medical CenterDr. Carfrae). Request for reprint: William H. Slytheri III, MD, House Ear Institute, clinical research department, 2100 W. 3rd St. 5/F ca900 57 Los Angeles. Phone: (213)483-9930; fax: (213)484-5900; e- Postage: wslattery @ hi.