Cochlear implant flap necrosis: adjunct hyperbaric oxygen therapy for prevention of explantation.
The most common complication resulting from cochlear implant surgery involves the skin flap: scalp breakdown, flap necrosis, and implant exposure requiring explantation. A 5.4 percent flap complication rate has been reported with the C-shaped postauricular flap (anteriorly-based on the superficial temporal and occipital arteries) in contrast to a 0 percent flap complication rate with the Australian inverted U-flap (inferiorly-based on the occipital artery). The literature is scant concerning detailed management of flap necrosis in order to obviate cochlear implant removal. Presented is an illustrative case of full thickness C-shaped flap necrosis with resultant exposure of a Nucleus multichannel implant. Successful wound management required pre- and postoperative hyperbaric oxygen in conjunction with a transposition flap closure of the scalp defect. Cochlear explantation was not necessary and rehabilitation and implant function were excellent 18 months postoperatively.
Schweitzer
V G
VG
Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan 48202.
Burtka
M J
MJ
D000328:Adult; D003054:Cochlear Implants; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D009336:Necrosis; D011183:Postoperative Complications / Q000473:pathology*; D013524:Surgical Flaps / Q000473:pathology*; D013530:Surgical Wound Infection / Q000517:prevention & control*