How we do it: A novel approach to the skin–abutment interface of the bone‐anchored hearing aid: use of local skin flaps

Abstract

Various techniques involving skin grafts have been described to obtain thin hairless immobile skin at the abutment interface of the bone-anchored hearing aid (BAHA), but none are without significant complications such as necrosis and/or infection leading to total graft failure. A novel technique involving four local thin skin flaps was developed to prevent serious complications. The procedure essentially involves raising skin flaps at the intradermal level leaving the hair follicles in the subcutaneous tissue, which is subsequently excised. We have used the skin-flap approach around 21 BAHAs on 19 patients (two patients had bilateral devices) and the only complications were minor skin loss immediately adjacent to the implants in two patients and mild skin infections, which settled with topical antibiotics, in three patients. The innovative technique described is simple and straightforward, and does not require any special instrumentation. Furthermore, it may have specific advantages, in terms of morbidity, over contemporary skin grafting methods primarily because of the retained intrinsic blood supply of the skin flaps.