Abstract
The objective of this historical cohort study is to identify if there are differences in soft tissue reactions and skin thickening between implantation of the percutaneous bone-anchored hearing implant (BAHI) using the dermatome or linear incision technique. All adult patients who received a BAHI between August 2005 and January 2013 were selected. One surgeon performed all procedures and only the dermatome and linear incision technique were used. A total of 132 patients/implants were included and significantly more patients with risk factors were seen in the linear incision cohort. A soft tissue reaction Holgers ≥1 was present in 18 patients (40.9 %) in the dermatome compared to 36 patients (40.9 %) in the linear incision group. A Holgers ≥2 was noticed in 9 (20.5 %) and 19 (21.6 %) patients, respectively. Skin thickening was described in 14 (31.8 %) and 11 patients (12.5 %) in, respectively, the dermatome and linear incision cohort, which was a significant difference (p = 0.001). Nevertheless, therapeutic interventions were effective. In conclusion, there was no significant difference in (adverse) soft tissue reactions; however, skin thickening was more present in the dermatome technique. In addition, significantly more patients with risk factors were allocated to the linear incision technique. Based on these results, the linear incision is advocated as preferred technique.
Highlights
Since the first implantation in 1977 by Tjellstrom, percutaneous bone-anchored hearing implants (BAHIs) offer an appealing solution in hearing rehabilitation for patients with a conductive or mixed hearing loss [1, 2] and singlesided deafness [3,4,5,6]
Patients were preoperatively screened for an increased risk of skin flap necrosis and underwent in general the linear incision technique if one or more possible risk factors were present
Statistically significant differences found in the presence of soft tissue reactions or adverse soft tissue reactions between patients who underwent surgery with the dermatome technique and patients operated with the linear incision technique in the current set up
Summary
Since the first implantation in 1977 by Tjellstrom, percutaneous bone-anchored hearing implants (BAHIs) offer an appealing solution in hearing rehabilitation for patients with a conductive or mixed hearing loss [1, 2] and singlesided deafness [3,4,5,6]. Depending on type of implant and abutment, surgical technique and postoperative care, soft tissue reactions are still occasionally a problem [7,8,9,10,11,12]. The dermatome and linear incision technique have been introduced with the goal to further minimize skin problems postoperatively [15, 16]. The dermatome technique was developed to standardize the pedicled flap technique and create a thinner skin graft.
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