title: Punch and Drill: Implantation of Bone Anchored Hearing Device Through a Minimal Skin Punch Incision Versus Implantation With Dermatome and Soft Tissue Reduction.
abstract: OBJECTIVE
  To compare 2 surgical techniques for implantation of a percutaneous bone anchored hearing device: (1) a minimal skin punch incision without additional skin incision or soft tissue reduction and (2) implantation with an epidermal flap and soft tissues reduction.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary care referral center.
  
  
  METHODS
  Forty patients consecutively implanted (18 males and 22 females). Twenty patients underwent implantation by means of epidermal flap and soft tissues reduction (dermatome group), and 20 patients underwent skin punch resection without soft tissues reduction (punch group).
  
  
  METHODS
  surgical adverse events, surgical time, skin healing, skin tolerance (Holgers classification), and skin appearance and implant failure.
  
  
  RESULTS
  The surgical time was shorter with the punch technique (P < .05). The postoperative healing was satisfactory in both groups. All implants were loaded after the healing period. The skin tolerance was good in both groups by Holgers classification (punch, 85.7%/dermatome, 86%) with no significant difference. There were no severe adverse skin events in the punch group. The appearance of the skin around the implant was improved by the punch technique.
  
  
  CONCLUSIONS
  The implantation of the currently available percutaneous bone anchored hearing implants with a minimal skin punch skin resection without additional skin incision or soft tissue reduction shortens the surgery and improves the postoperative appearance. The skin tolerance is at least as good as with techniques with that include soft tissue reduction.
authors.affiliation: Jean Causse Ear Clinic, Colombiers, France t.dumon@clinique-causse.com.
authors.forename: Thibaud
authors.initials: T
authors.lastname: Dumon
authors.affiliation: Hospital Universitario Rey Juan Carlos, Madrid, Spain.
authors.forename: Marimar
authors.initials: M
authors.lastname: Medina
authors.affiliation: Weill Cornell Medical College, New York, New York, USA.
authors.forename: Neil M
authors.initials: NM
authors.lastname: Sperling
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006310:Hearing Aids; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D013506:Otologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012867:Skin / Q000503:physiopathology; D053441:Suture Anchors; D014945:Wound Healing; D055815:Young Adult
keywords: BAHA; bone anchored implants; complications; surgical outcomes; unilateral hearing loss