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The use of full-thickness skin grafts for the skin-abutment interface around bone-anchored hearing aids
Mary C Snyder1, Gary F Moore, Perry J Johnson
1Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE 68198-1225, USA. msnyder@unmc.edu
Objective:
To review the complication rate encountered with the use of full-thickness skin grafts to establish the skin-abutment interface around bone-anchored hearing aid implants.
Study Design:
Retrospective chart review.
Setting:
Tertiary referral center.
Patients:
Fifteen patients who underwent bone-anchored hearing aid placement over a 4-year period.
Intervention:
Each percutaneous titanium implant and abutment was placed into the temporal bone following the standard Branemark technique. Eight procedures were performed in two stages, and seven were performed as single-stage procedures. In all cases, the skin-abutment interface was established by use of a full-thickness skin graft inset around the implant.
Main Outcome Measures:
The incidence of complications resulting in skin graft loss, time from implantation to bone-anchored hearing aid use, additional procedures for revision of the interface, and complicating medical factors in the patient population.
Results:
Seven patients (46.7%) experienced loss of the full-thickness skin graft around the abutment. Four of these seven had complicating medical factors associated with impaired wound healing: two with diabetes mellitus, one of whom was also a smoker, and two patients who were receiving inhaled steroids for treatment of asthma. Of the seven patients who lost skin grafts, two healed by secondary intention, two underwent repeated full-thickness skin grafting, and three underwent galeal rotation flaps with split-thickness skin grafting, one of which eventually required a scalp flap. No patient experienced loss of the implant.
Conclusion:
The use of full-thickness skin grafts for establishment of the skin-abutment interface around bone-anchored hearing aid implants is associated with a high rate of graft loss. Although salvage techniques can successfully establish the interface after skin graft failure, alternative methods should be considered, especially in high-risk patients.
