title: Cause and repair of flap necrosis over cochlear implant.
abstract: OBJECTIVE
  The aim of this report was to study the cause and treatment of flap-related complications over cochlear implant.
  
  
  METHODS
  The study was performed in an academic tertiary referral center.
  
  
  METHODS
  A 53-year-old Japanese male patient had had two retro-auricular skin incisions for tympanomastoidectomy in the postauricular region before implantation of a cochlear implant. He also had worn a helmet daily during work in his factory.
  
  
  METHODS
  Corrective surgery was performed for reformation of the local blood supply to the overlying skin flap and reinforcement of the tissue overlying the implant by use of a superiorly based temporal muscle and fascia flap that were sutured with an inferiorly based muscle and fascia flap.
  
  
  RESULTS
  We successfully transposed the flap covering the implant without explantation of the implant.
  
  
  CONCLUSIONS
  The delayed development of flap necrosis was thought to be due to pressure necrosis produced by the band in the patient's helmet lying on the skin over the implant and to poor local blood supply in the postauricular area stemming from the two previous skin incisions for mastoid surgery performed for cholesteatoma. In those patients who wear helmets, it is important to position the cochlear implant sufficiently behind the ear and to avoid the use of a helmet.
authors.affiliation: Department of Otolaryngology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ishida
authors.forename: A
authors.initials: A
authors.lastname: Shinkawa
authors.forename: M
authors.initials: M
authors.lastname: Sakai
authors.forename: Y
authors.initials: Y
authors.lastname: Tamura
authors.forename: A
authors.initials: A
authors.lastname: Naito
mesh_terms: D003054:Cochlear Implants; D006319:Hearing Loss, Sensorineural / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012086:Reoperation; D013524:Surgical Flaps / Q000009:adverse effects*