COMPLETE or "pantympanic" perforations denote total loss of the tympanic membrane with the exception of a rim of pars tensa left as a remnant which is actually the annulus of the pars tensa. This perforation usually excludes the pars flaccida of the drum. Initial grafting procedures to perforations of the tympanic membrane were first reported about ten years ago. 1,2 A significant improvement in results occurred with evolution to the use of external canal skin grafts in the repair of these perforations. 3-5 Additional materials, namely vein or fascia, soon followed the use of canal skin in the evolution of this surgical procedure. 6,7 The cases reported in this paper are restricted to those persons having complete loss of the tympanic membrane before grafting. The grafting procedure shown uses two tissues, namely vein and canal skin in combination. The use of this combination was first introduced and reported by