title: Skin flap complications after cochlear implantations.
abstract: The objective of the study was to analyse and present the surgical management strategy for major skin flap complications (MSFC) after cochlear implantations. Patients fitted with a titanium-silicone-coated implant of the same kind, operated on between 1994 and 2013 with a standardised procedure (1076 medical charts) were analysed. Analysis aimed to identify and study individuals with skin problems related to the cochlear implant treatment, i.e. requiring surgical treatment in hospital defined as MSFC and focused on incidence, risk factors and treatment of MSFC. MSFC were diagnosed in 1.76 % of patients: 2.06 % of children and 1.35 % of adults, 2.43 % after implantation with a long "C"-shaped incision and 1.28 % after short retroauricular incision. Registered risk factors included head trauma, acute otitis media, poor hygiene in children, and general comorbidities in adults. The primary intervention was dependent on skin complication severity and included revision surgery with wound closure over an implant (52.6 %) and revision surgery with explantation (47.4 %). Revision surgery without explantation was successful in 40 % and the most effective approach was debridement with a two-layer rotational flap. Explantation led to ultimate wound healing in all cases. Major skin flap complications after cochlear implantation are rare, but their treatment is complex and difficult. Revision surgery with resection of infected tissue, formation of a rotational two-layer flap preceded and supplemented by intensive targeted antibiotic therapy can be effective and should be the first treatment option. Spontaneous implant explantation, abscess formation or unsuccessful primary treatment necessitate implant removal as the ultimate solution.
authors.affiliation: Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, Poznań, Poland. wojgaw@interia.pl.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Gawęcki
authors.affiliation: Department of Phoniatrics and Audiology, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Karlik
authors.affiliation: Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Borucki
authors.affiliation: Department of Dermatology, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Szyfter-Harris
authors.affiliation: Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Wróbel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation; D003054:Cochlear Implants; D015897:Comorbidity; D006259:Craniocerebral Trauma / Q000453:epidemiology; D003646:Debridement; D005260:Female; D006801:Humans; D006920:Hygiene; D007223:Infant; D008297:Male; D008875:Middle Aged; D010033:Otitis Media / Q000453:epidemiology; D011044:Poland / Q000453:epidemiology; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cochlear implantation; Explantation; Reimplantation; Rotational two-layer flap; Skin flap complications