title: Vascular mapping of the retroauricular skin - proposal for a posterior superior surgical incision for transcutaneous bone-conduction hearing implants.
abstract: BACKGROUND
  Passive transcutaneous osseointegrated hearing implant systems have become increasingly popular more recently. The area over the implant is vulnerable due to vibration and pressure from the externally worn sound processor. Good perfusion and neural integrity has the potential to reduce complications. The authors' objective was to determine the ideal surgical exposure to maintain perfusion and neural integrity and decrease surgical time as a result of reduced bleeding.
  
  
  METHODS
  The vascular anatomy of the temporal-parietal soft tissue was examined in a total of 50 subjects. Imaging diagnostics included magnetic resonance angiography in 12 and Doppler ultrasound in 25 healthy subjects to reveal the arterial network. Cadaver dissection of 13 subjects formed the control group. The prevalence of the arteries were statistically analyzed with sector analysis in the surgically relevant area.
  
  
  RESULTS
  The main arterial branches of this region could be well identified with each method. Statistical analysis showed that the arterial pattern was similar in all subjects. The prevalence of major arteries is low in the upper posterior area though large in proximity to the auricle region.
  
  
  CONCLUSIONS
  Diverse methods indicate the advantages of a posterior superior incision because the major arteries and nerves are at less risk of damage and best preserved. Although injury to these structures is rare, when it occurs, the distal flow is compromised and the peri-implant area is left intact. Hand-held Doppler is efficient and cost-effective in finding the best position for incision, if necessary, in subjects with a history of surgical stress to the retroauricular skin.
  
  
  BACKGROUND
  This was a non-interventional study.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Tisza Lajos krt. 111, H-6725, Szeged, Hungary. perenyi.adam@med.u-szeged.hu.
authors.forename: Adam
authors.initials: A
authors.lastname: Perenyi
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Tisza Lajos krt. 111, H-6725, Szeged, Hungary.
authors.forename: Zsofia
authors.initials: Z
authors.lastname: Bere
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Tisza Lajos krt. 111, H-6725, Szeged, Hungary.
authors.forename: Janos
authors.initials: J
authors.lastname: Jarabin
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Tisza Lajos krt. 111, H-6725, Szeged, Hungary.
authors.forename: Balazs
authors.initials: B
authors.lastname: Sztano
authors.affiliation: Affidea Diagnosztika kft., Semmelweis u. 6, H-6725, Szeged, Hungary.
authors.forename: Edit
authors.initials: E
authors.lastname: Kukla
authors.affiliation: Affidea Diagnosztika kft., Semmelweis u. 6, H-6725, Szeged, Hungary.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Bikhazi
authors.affiliation: Department of Pathology, University of Szeged, Állomás u. 2, H-6725, Szeged, Hungary.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Tiszlavicz
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Tisza Lajos krt. 111, H-6725, Szeged, Hungary.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Toth
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Tisza Lajos krt. 111, H-6725, Szeged, Hungary.
authors.forename: Jozsef Geza
authors.initials: JG
authors.lastname: Kiss
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Tisza Lajos krt. 111, H-6725, Szeged, Hungary.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Rovo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001844:Bone Conduction; D002102:Cadaver; D019929:Cochlear Implantation; D003054:Cochlear Implants; D004210:Dissection; D054644:Ear Auricle / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D006257:Head / Q000098:blood supply* / Q000000981:diagnostic imaging; D006314:Hearing Loss, Conductive / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000098:blood supply* / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler; D055815:Young Adult
keywords: Arterial network; Bone-anchored hearing aid; Conductive hearing loss; Doppler ultrasound; Ear surgery; Numbness; Skin necrosis; Temporal parietal soft tissue