title: Management of late extrusions of cochlear implants.
abstract: OBJECTIVE
  The study aimed to identify the important principles in repairing and preventing delayed cochlear implant extrusions.
  
  
  METHODS
  The study design was a retrospective, international database review and three case presentations from the authors' local database.
  
  
  METHODS
  The study was conducted at a tertiary referral center.
  
  
  METHODS
  Cochlear Corporation's database of 8,665 implantees in North and South America and Israel was studied. A subset of this database, consisting of 74 patients implanted through the Louisiana State University/Eye, Ear, Nose and Throat (LSU/EENT) project, is analyzed separately and provides the case reports.
  
  
  METHODS
  Surgical repair of skin breakdown over the edge of three cochlear implants using a two-layer, pericranial and scalp rotation flap technique was performed.
  
  
  METHODS
  A functioning cochlear implant with a healthy skin covering was measured.
  
  
  RESULTS
  The three LSU/EENT cases reported here used a pericranial flap to repair the capsule of the implant and a large scalp rotation flap to repair the skin defect. A novel pericranial tuck-under technique is especially useful for the Nucleus Mini-22 implant. With this technique, the authors have had a 100% success rate (3 of 3). The basic principles used in the repair and in the initial implant surgery are discussed.
  
  
  CONCLUSIONS
  The following conclusions were reached: 1) avoid skin closure lines parallel to the cochlear implant edge that are closer than 1.5 cm from the implant edge; 2) excise enough skin and scar around the dehiscence to achieve principle 1; 3) design a large, well-vascularized anterior- or posterior-based scalp rotation flap to cover this defect; and 4) close the implant capsule defect with a well-vascularized pericranial flap.
authors.affiliation: Louisiana State University Medical Center, Department of Otolaryngology--Head and Neck Surgery, New Orleans 70112, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Parkins
authors.forename: S E
authors.initials: SE
authors.lastname: Metzinger
authors.forename: H W
authors.initials: HW
authors.lastname: Marks
authors.forename: G D
authors.initials: GD
authors.lastname: Lyons
mesh_terms: D000328:Adult; D002648:Child; D003054:Cochlear Implants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013536:Suture Techniques; D013997:Time Factors