Single Vertical Incision for BAHA: Preliminary Results

Abstract

Objective A single vertical skin incision with subcutaneous tissue undermining is a cosmetic alternative to standard dermatome skin graft elevation for bone anchored hearing aid (BAHA) placement. A vertical incision minimizes alopecia and simplifies wound closure, while maintaining thin skin flaps. We aimed to determine the preliminary complication rate using a 4cm skin inicsion with 4⋉4 cm of subcutaneous tissue removal. Methods A retrospective chart review of patients undergoing BAHA placement from January 2006 to August 2007 was performed. This search was filtered to include only vertical incision BAHA patients. Complications including skin irritation or infection, skin overgrowth, and implant extrusion were tallied. Pertinent patient risk factors were identified. 71 patients underwent vertical incision surgery, with a mean followup time of 6.8 months. 50 patients had sensorineural hearing losses and 21 had conductive hearing losses. Results No patient had spontaneous extrusion of the titanium abutment. There were 5 minor complications (skin irritation 3, wound infection requiring oral antibiotics 1, postoperative hematoma 1) and 7 major complications (irritation requiring abutment removal 1, skin overgrowth or infection requiring flap revision 6). Total complication rate was 16% and major complication rate was 9.8%. Conclusions A single vertical incision for BAHA placement has a similar complication rate to traditional dermatome use in this preliminary study, though more follow-up is necessary to identify cases of late skin overgrowth. Patients with thick scalps or risk factors for hypertrophic scarring may require placement of longer abutments.