“…The addition of bFGF [5], a growth factor that stimulates neovascularisation and the proliferation of epidermal and connective tissue cells [6], should improve the rate of successful closure of perforated TMs and extend the treatment indications [7][8][9][10]. Lou et al reported that the direct application of FGF improved healing and shortened the closure time of acute traumatic perforations [5]. For chronic TM perforations, however, mechanical disruption of the edge of the perforation is required to stimulate the activity of TM stem cells [10], because the outer squamous epithelium of the TM grows medially around the edge of the perforation contacting the inner mucosal layer and acts as a limiting healing barrier on the middle connective tissue layer, preventing closure of the perforation [11].…”