title: Osseointegrated implants for auricular defects: operative techniques and complication management.
abstract: OBJECTIVE
  Auricular defects are challenging to reconstruct with native tissue. We describe operative techniques and complication management for patients undergoing osseointegrated implants for auriculectomy defects and microtia.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  All patients at Duke University Medical Center with auricular defects treated with osseointegrated implants for prosthetic (OIP) auricles from January 1, 2010, until September 16, 2013.
  
  
  METHODS
  Osseointegrated implantation for auricular defects.
  
  
  METHODS
  Description of operative techniques, complications, and complication management.
  
  
  RESULTS
  Sixteen patients met inclusion criteria. Five patients had microtia and atresia. Two of these patients had bilateral microtia and atresia and underwent bilateral simultaneous implantation of both OIP and osseointegrated hearing implants (OHIs). Two other microtia/atresia patients underwent simultaneous unilateral OIP and OHI. Eleven patients had unilateral defects from either trauma or skin cancer resection. Three patients received adjuvant radiation before implantation. Complications included tissue overgrowth requiring revision surgery (two patients), inadequate bone stock requiring split calvarial bone graft and later implantation, loss of implant secondary to osteoradionecrosis requiring hyperbaric oxygen therapy, and skin infection requiring antibiotic therapy.
  
  
  CONCLUSIONS
  Reconstruction of auriculectomy defects and microtia is difficult to accomplish using native tissue. Complications are common, and these complications can have devastating consequences on the final result. Osseointegrated implantation offers an outstanding alternative for reconstructing these defects. We describe our multidisciplinary team approach, examine operative techniques, and focus on the unique challenges of simultaneous and bilateral simultaneous OIP and OHI implantation.
authors.affiliation: *Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, †Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, and ‡The Anaplastology Clinic, Duke University Medical Center, Durham, North Carolina, U.S.A.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Rocke
authors.forename: Debara L
authors.initials: DL
authors.lastname: Tucci
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Marcus
authors.forename: Jay
authors.initials: J
authors.lastname: McClennen
authors.forename: David
authors.initials: D
authors.lastname: Kaylie
mesh_terms: D000328:Adult; D000368:Aged; D054644:Ear Auricle / Q000002:abnormalities / Q000601:surgery*; D005260:Female; D006310:Hearing Aids; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D011183:Postoperative Complications / Q000453:epidemiology*; D019736:Prostheses and Implants / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000379:methods*