title: Patient satisfaction and aesthetic outcomes after ear reconstruction with a Branemark-type, bone-anchored, ear prosthesis: a 16 year review.
abstract: BACKGROUND
  Reconstruction of the human ear with a bone-anchored prosthesis is a widely accepted alternative when autologous reconstruction is technically impossible or declined by the individual. However, there are relatively few data in the literature documenting patient satisfaction with this form of reconstruction.
  
  
  METHODS
  This study examines different aspects of patient satisfaction using an eighteen-point postal questionnaire to measure patient outcomes against a Likert rating scale. The questionnaire was sent to 33 patients who completed prosthetic ear reconstruction over a 16 year period at a specialist plastic surgery unit in the United Kingdom. Medical case notes for these cases were also reviewed. Twenty completed questionnaires were returned.
  
  
  RESULTS
  The response rate was 61%. The majority of patients were satisfied with the aesthetics, ease of handling and comfort of the bone-anchored implant and prosthesis. However, the majority of patients was only moderately satisfied or was dissatisfied with this method of reconstruction. Specifically, 15 of the respondents reported skin problems around the abutments of the bone-anchored implant with 10 patients reporting ongoing skin complications. Granulation tissue was the most common skin problem (12 cases) followed by local infection (10 cases). Interestingly, despite the chronic skin problems, most patients indicated that they would undergo the same procedure again or would recommend it to others.
  
  
  CONCLUSIONS
  Our survey shows that patients fitted with a Branemark-type bone-anchored implant for ear reconstruction are pleased with the aesthetic appearance but experience multiple, chronic, skin complications and other implant related problems. These affect their satisfaction with this method of reconstruction. Our findings may have significant implications for patients and surgeons considering this form of reconstruction and for the institutions making decisions about funding this treatment.
authors.affiliation: Royal Free Hospital, Pond Street, London NW3 2QG, UK. i.younis@hotmail.com
authors.forename: Ibby
authors.initials: I
authors.lastname: Younis
authors.forename: David
authors.initials: D
authors.lastname: Gault
authors.forename: Walid
authors.initials: W
authors.lastname: Sabbagh
authors.forename: Norbert V
authors.initials: NV
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D000328:Adult; D004431:Ear, External / Q000002:abnormalities / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D053441:Suture Anchors; D016896:Treatment Outcome