title: The use of full-thickness skin grafts for the skin-abutment interface around bone-anchored hearing aids.
abstract: OBJECTIVE
  To review the complication rate encountered with the use of full-thickness skin grafts to establish the skin-abutment interface around bone-anchored hearing aid implants.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Fifteen patients who underwent bone-anchored hearing aid placement over a 4-year period.
  
  
  METHODS
  Each percutaneous titanium implant and abutment was placed into the temporal bone following the standard Branemark technique. Eight procedures were performed in two stages, and seven were performed as single-stage procedures. In all cases, the skin-abutment interface was established by use of a full-thickness skin graft inset around the implant.
  
  
  METHODS
  The incidence of complications resulting in skin graft loss, time from implantation to bone-anchored hearing aid use, additional procedures for revision of the interface, and complicating medical factors in the patient population.
  
  
  RESULTS
  Seven patients (46.7%) experienced loss of the full-thickness skin graft around the abutment. Four of these seven had complicating medical factors associated with impaired wound healing: two with diabetes mellitus, one of whom was also a smoker, and two patients who were receiving inhaled steroids for treatment of asthma. Of the seven patients who lost skin grafts, two healed by secondary intention, two underwent repeated full-thickness skin grafting, and three underwent galeal rotation flaps with split-thickness skin grafting, one of which eventually required a scalp flap. No patient experienced loss of the implant.
  
  
  CONCLUSIONS
  The use of full-thickness skin grafts for establishment of the skin-abutment interface around bone-anchored hearing aid implants is associated with a high rate of graft loss. Although salvage techniques can successfully establish the interface after skin graft failure, alternative methods should be considered, especially in high-risk patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE 68198-1225, USA. msnyder@unmc.edu
authors.forename: Mary C
authors.initials: MC
authors.lastname: Snyder
authors.forename: Gary F
authors.initials: GF
authors.lastname: Moore
authors.forename: Perry J
authors.initials: PJ
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D004558:Electric Stimulation / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006085:Graft Survival; D006310:Hearing Aids; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D012189:Retrospective Studies; D012871:Skin Diseases / Q000601:surgery*; D016038:Skin Transplantation; D013701:Temporal Bone