Management of flap necrosis in cochlear implantation

Skin flap complications are the most commonly reported problems in cochlear implant surgery when the anteriorly based C-shaped flap is used for the incision. If the prosthesis is exposed by flap necrosis, local skin flaps may be used to obtain coverage. Unfortunately, the long-term viability of such flaps may be compromised by the pressure exerted by the transmitter. Two cases of flap necrosis severe enough to expose the prosthesis have been successfully managed by relocating the device to a position superior to the auricle, under healthy skin. In one case the receiver was removed owing to infection and reimplanted at a later date. In this case, the electrode array was left in place at explantation in order to stent the cochlea. The surgical techniques and flap designs for this procedure are presented. No further surgical complications have developed in either case. The devices are performing well for both patients at this time. We have found relocation of the implant a useful technique in the management of major flap necrosis. This technique may also be useful to prevent flap necrosis should excessive flap thinning occur during the implant operation.