title: Bone-anchored Hearing Implant Surgery: Randomized Trial of Dermatome Versus Linear Incision Without Soft Tissue Reduction--Clinical Measures.
abstract: OBJECTIVE
  Assessment of differences in soft tissue healing and long-term issues between two techniques for bone-anchored hearing implant (BAHI) surgery.
  
  
  METHODS
  Single-center, randomized, nonblinded study using balanced randomization (1:1).
  
  
  METHODS
  Tertiary referral center in the Central Denmark Region.
  
  
  METHODS
  Forty-seven adults with normal skin quality.
  
  
  METHODS
  Operation with a BAHI system with randomization to 1) dermatome technique with soft tissue removal and 2) linear incision with no soft tissue reduction.
  
  
  METHODS
  Holgers' score, pain, and sensibility loss assessed at 0, 3, 7, 10, 14, and 21 days and 1, 3, 6, and 12 months postoperatively. Implant loss.
  
  
  RESULTS
  Forty-nine patients were randomized (linear incision, n = 25; dermatome, n = 24). Forty-seven patients were analyzed (linear incision, n = 25; dermatome, n = 22). Differences in proportions for grouped data (outcome 0 and outcome >0) for the total of all visits were Holgers' Index: 0.13 (p = 0.0004; 95% confidence interval [95% CI], 0.058-0.21); sensibility loss: 0.50 (p = 2.2 · 10; 95% CI, 0.42-0.58); pain: 0.096 (p = 0.006; 95% CI, 0.026-0.17). Soft tissue reactions and pain were most prominent in the early postoperative period, whereas issues with sensibility loss subsided throughout the 1-year follow-up period. No implants were lost.
  
  
  CONCLUSIONS
  In a randomized trial for BAHI surgery, the linear incision with no subcutaneous reduction had a faster healing time and inflicted less pain and sensibility loss than the dermatome technique. The long-term soft tissue problems were similar in the two groups, thus favoring the linear incision, which is less invasive.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Høgsbro
authors.forename: Andreas
authors.initials: A
authors.lastname: Agger
authors.forename: Lars Vendelbo
authors.initials: LV
authors.lastname: Johansen
mesh_terms: D000328:Adult; D000368:Aged; D001844:Bone Conduction; D003718:Denmark; D005260:Female; D006309:Hearing; D006310:Hearing Aids; D006801:Humans; D008297:Male; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D012867:Skin / Q000294:innervation; D053441:Suture Anchors; D014945:Wound Healing