title: BAHA implant: implantation technique and complications.
abstract: OBJECTIVE
  BAHA implants have been shown to be effective in certain forms of conductive hearing loss, but the presence of the titanium abutment is responsible for sometimes severe skin reactions. The objective of this study was to compare two operative techniques: skin flap, and full-thickness skin graft.
  
  
  METHODS
  Between January 2004 and January 2011, 72 patients were treated by BAHA implant and 32 of these patients (total of 41 implants) were included in the study. Two surgical techniques were used: full-thickness skin graft (n=21) and skin flap (n=20).
  
  
  RESULTS
  Four types of skin complications were observed: necrosis, inflammation/infection, hypertrophic scar, and fixture loss due to inadequate osseointegration. Complications requiring surgical revision were observed in 20% of cases with the skin flap method and 38% of cases with the skin graft technique, with no significant difference between the two groups (P=0.31).
  
  
  CONCLUSIONS
  The skin graft technique appears to be associated with a higher rate of major complications. The most common complication is hypertrophic scar. The apparently high complication rate in this series can be explained by a selection bias (exclusion of a large number of complication-free patients).
authors.affiliation: Service d'ORL, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France. Electronic address: Nicolas.fontaine@chru-strasbourg.fr.
authors.forename: N
authors.initials: N
authors.lastname: Fontaine
authors.affiliation: Service d'ORL, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France.
authors.forename: P
authors.initials: P
authors.lastname: Hemar
authors.affiliation: Service d'ORL, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France.
authors.forename: P
authors.initials: P
authors.lastname: Schultz
authors.affiliation: Service d'ORL, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France.
authors.forename: A
authors.initials: A
authors.lastname: Charpiot
authors.affiliation: Service d'ORL, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France.
authors.forename: C
authors.initials: C
authors.lastname: Debry
mesh_terms: D000328:Adult; D005260:Female; D006310:Hearing Aids; D006801:Humans; D008297:Male; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000009:adverse effects*; D013524:Surgical Flaps / Q000009:adverse effects*
keywords: BAHA; Hypertrophic scar; Skin complications; Skin flap; Skin graft; Surgical technique