title: Skin reactions after BAHA surgery: a comparison between the U-graft technique and the BAHA dermatome.
abstract: OBJECTIVE
  To compare and evaluate 2 surgical methods for handling the soft tissues in Bone-Anchored Hearing Aid (BAHA) surgery: the U-graft technique versus the dermatome designed for BAHA site preparation.
  
  
  BACKGROUND
  Skin reactions surrounding the percutaneous titanium abutment of the BAHA are a matter of clinical concern. Excessive residual soft tissue surrounding the implant is thought to be the principal cause of this complication. To address the challenge of adequately thinning the soft tissue, a dermatome has been introduced to facilitate BAHA site preparation.
  
  
  METHODS
  All patients fitted with a BAHA between 2001 and 2004 at our clinic were included in the study. Resection of soft tissue associated with the use of the U-graft technique or the dermatome was documented. At follow-up, skin reactions were registered according to Holgers. Here, we comparatively analyze the fate of the implant site according to the soft tissue resection technique used.
  
  
  RESULTS
  We used a U-shaped graft in 45 patients; the dermatome was used in 25 patients. A total of 373 observations were recorded in follow-up. In the U-shaped graft group, 29 (64%) of 45 patients experienced no adverse skin reactions. In the BAHA dermatome group, 21 (84%) of the 25 patients experienced no skin reactions. The difference in adverse skin reactions between the 2 groups was 19.6% (p = 0.14; 95% confidence interval, -3.6 to 42.7%).
  
  
  CONCLUSIONS
  The BAHA dermatome is a tool, which achieves BAHA skin-healing outcomes at least as good as U-graft flaps created by long-experienced BAHA surgeons. Perhaps, this tool allow other BAHA surgeons to achieve similar outcomes without having to experience as many skin reactions as occurred in the evolution of skin management around BAHA abutments.
authors.affiliation: Ear, Nose, Throat Department, Sahlgrenska University Hospital, Göteborg, Sweden. joacim@stalfors.se
authors.forename: Joacim
authors.initials: J
authors.lastname: Stalfors
authors.forename: Anders
authors.initials: A
authors.lastname: Tjellström