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Percutaneous bone-anchored hearing implant surgery without soft-tissue reduction: up to 42 months of follow-up.

Singam S, Williams R, Saxby C, Houlihan FP - Otol. Neurotol. (2014)

Bottom Line: Unlike in traditional techniques where all dermal and subcutaneous tissue and muscle are removed to enable the thinned skin to sit directly on the periosteum, here, in our series, using the WoSR technique, the soft tissue was preserved and only longer abutments (8.5, 9, and 12 mm) were used.Good early postoperative wound healing, absence of flap necrosis, absence of numbness around the surgical site, and trouble-free follow-up period, with 25 patients encountering no complications.Of the 30 patients, 25 have had no postoperative problems and five had mild inflammation, of which three patients developed intractable pain and underwent soft-tissue reduction.

View Article: PubMed Central - PubMed

Affiliation: *Torbay Hospital, Devon; and †Institute of Naval Medicine, Gosport, England, United Kingdom.

ABSTRACT

Objective: To report the results of bone-anchored hearing implant (BAHI) surgery without soft-tissue reduction (WoSR); in our case, a series of 30 patients with a follow-up period of up to 42 months.

Patients: The study group included 30 patients between ages 17 and 79 years, where BAHI was indicated, during a 42-month period, between February 2010 and July 2013. Initially, only patients with medical comorbidities that could compromise wound healing were offered the procedure but, subsequently, all our patients are now offered this technique.

Intervention: Unlike in traditional techniques where all dermal and subcutaneous tissue and muscle are removed to enable the thinned skin to sit directly on the periosteum, here, in our series, using the WoSR technique, the soft tissue was preserved and only longer abutments (8.5, 9, and 12 mm) were used.

Main outcome measure: Good early postoperative wound healing, absence of flap necrosis, absence of numbness around the surgical site, and trouble-free follow-up period, with 25 patients encountering no complications.

Results: Of the 30 patients, 25 have had no postoperative problems and five had mild inflammation, of which three patients developed intractable pain and underwent soft-tissue reduction.

Conclusion: The technique WoSR for BAHI surgery seems to be a safe technique with consistently good results, decreasing operating time and patient morbidity and avoiding some of the complications seen in traditional techniques using soft-tissue reduction.

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Related in: MedlinePlus

WoSR technique: (A) site marked; (B) 6-mm skin punch; (C) removal of tissue core with periosteum; (D) linear incision for access; (E) the implant in position; and (F) dressing with healing cap.
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Figure 1: WoSR technique: (A) site marked; (B) 6-mm skin punch; (C) removal of tissue core with periosteum; (D) linear incision for access; (E) the implant in position; and (F) dressing with healing cap.

Mentions: The patient is positioned and hair is shaved, as for traditional BAHI surgery, and the outline of the desired dummy bone-anchored hearing aid is marked, along with the corresponding abutment position. The patient is then prepped and draped, and local anesthetic with adrenaline is infiltrated. A 6-mm skin biopsy punch is used to cut through soft tissues, down to the bone, and a core of tissue including the periosteum is removed at the marked abutment position (Fig. 1). A linear incision is then made down to periosteum along the longitudinal axis of the perceived BAHI position (Fig. 1). With bone exposed, bone work proceeds in the traditional way. A 4-mm fixture with an 8.5- or 9-mm abutment is placed in most cases. A 12-mm abutment is used, if soft-tissue thickness dictates. In our experience, the length of the cutting end of the punch is 8 mm and provides a useful guide to the abutment needed. If the periosteum is reached with ease, then the 8.5- or 9-mm abutment is used. If, however, the periosteum could only be reached with significant pressure, then a 12-mm abutment is used. Our patient population has not needed abutments longer than 12 mm. The incision is closed with 5-0 nonabsorbable polypropylene sutures, dressed with a nanocrystalline silver dressing and a nonadhesive absorbent sponge dressing with the healing cap. This is left in situ for 1 week. A mastoid bandage is applied, which the patient removes at home in 48 hours. This reduces the risk of early displacement of the dressing and healing cap, which can lead to troublesome edema around the abutment. One week postoperatively, the dressings and sutures are removed and the patient is instructed to carry out daily wound care with alcohol wipes and mupirocin antibacterial ointment. At the second review, two weeks postoperatively, the wound is checked and local hair trimming instructions are given to keep hairs trimmed approximately 1 cm around abutment. The BAHA processor is then fitted 2 months postoperatively (although currently earlier loading is being studied and being carried out in various centers).


Percutaneous bone-anchored hearing implant surgery without soft-tissue reduction: up to 42 months of follow-up.

Singam S, Williams R, Saxby C, Houlihan FP - Otol. Neurotol. (2014)

WoSR technique: (A) site marked; (B) 6-mm skin punch; (C) removal of tissue core with periosteum; (D) linear incision for access; (E) the implant in position; and (F) dressing with healing cap.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554229&req=5

Figure 1: WoSR technique: (A) site marked; (B) 6-mm skin punch; (C) removal of tissue core with periosteum; (D) linear incision for access; (E) the implant in position; and (F) dressing with healing cap.
Mentions: The patient is positioned and hair is shaved, as for traditional BAHI surgery, and the outline of the desired dummy bone-anchored hearing aid is marked, along with the corresponding abutment position. The patient is then prepped and draped, and local anesthetic with adrenaline is infiltrated. A 6-mm skin biopsy punch is used to cut through soft tissues, down to the bone, and a core of tissue including the periosteum is removed at the marked abutment position (Fig. 1). A linear incision is then made down to periosteum along the longitudinal axis of the perceived BAHI position (Fig. 1). With bone exposed, bone work proceeds in the traditional way. A 4-mm fixture with an 8.5- or 9-mm abutment is placed in most cases. A 12-mm abutment is used, if soft-tissue thickness dictates. In our experience, the length of the cutting end of the punch is 8 mm and provides a useful guide to the abutment needed. If the periosteum is reached with ease, then the 8.5- or 9-mm abutment is used. If, however, the periosteum could only be reached with significant pressure, then a 12-mm abutment is used. Our patient population has not needed abutments longer than 12 mm. The incision is closed with 5-0 nonabsorbable polypropylene sutures, dressed with a nanocrystalline silver dressing and a nonadhesive absorbent sponge dressing with the healing cap. This is left in situ for 1 week. A mastoid bandage is applied, which the patient removes at home in 48 hours. This reduces the risk of early displacement of the dressing and healing cap, which can lead to troublesome edema around the abutment. One week postoperatively, the dressings and sutures are removed and the patient is instructed to carry out daily wound care with alcohol wipes and mupirocin antibacterial ointment. At the second review, two weeks postoperatively, the wound is checked and local hair trimming instructions are given to keep hairs trimmed approximately 1 cm around abutment. The BAHA processor is then fitted 2 months postoperatively (although currently earlier loading is being studied and being carried out in various centers).

Bottom Line: Unlike in traditional techniques where all dermal and subcutaneous tissue and muscle are removed to enable the thinned skin to sit directly on the periosteum, here, in our series, using the WoSR technique, the soft tissue was preserved and only longer abutments (8.5, 9, and 12 mm) were used.Good early postoperative wound healing, absence of flap necrosis, absence of numbness around the surgical site, and trouble-free follow-up period, with 25 patients encountering no complications.Of the 30 patients, 25 have had no postoperative problems and five had mild inflammation, of which three patients developed intractable pain and underwent soft-tissue reduction.

View Article: PubMed Central - PubMed

Affiliation: *Torbay Hospital, Devon; and †Institute of Naval Medicine, Gosport, England, United Kingdom.

ABSTRACT

Objective: To report the results of bone-anchored hearing implant (BAHI) surgery without soft-tissue reduction (WoSR); in our case, a series of 30 patients with a follow-up period of up to 42 months.

Patients: The study group included 30 patients between ages 17 and 79 years, where BAHI was indicated, during a 42-month period, between February 2010 and July 2013. Initially, only patients with medical comorbidities that could compromise wound healing were offered the procedure but, subsequently, all our patients are now offered this technique.

Intervention: Unlike in traditional techniques where all dermal and subcutaneous tissue and muscle are removed to enable the thinned skin to sit directly on the periosteum, here, in our series, using the WoSR technique, the soft tissue was preserved and only longer abutments (8.5, 9, and 12 mm) were used.

Main outcome measure: Good early postoperative wound healing, absence of flap necrosis, absence of numbness around the surgical site, and trouble-free follow-up period, with 25 patients encountering no complications.

Results: Of the 30 patients, 25 have had no postoperative problems and five had mild inflammation, of which three patients developed intractable pain and underwent soft-tissue reduction.

Conclusion: The technique WoSR for BAHI surgery seems to be a safe technique with consistently good results, decreasing operating time and patient morbidity and avoiding some of the complications seen in traditional techniques using soft-tissue reduction.

Show MeSH
Related in: MedlinePlus