Cochlear implant flap necrosis: adjunct hyperbaric oxygen therapy for prevention of explantation

The most common complication resulting from cochlear implant surgery involves the skin flap: scalp breakdown, flap necrosis, and implant exposure requiring explantation. A 5.4 percent flap complication rate has been reported with the C-shaped postauricular flap (anteriorly-based on the superficial temporal and occipital arteries) in contrast to a 0 percent flap complication rate with the Australian inverted U-flap (inferiorly-based on the occipital artery). The literature is scant concerning detailed management of flap necrosis in order to obviate cochlear implant removal. Presented is an illustrative case of full thickness C-shaped flap necrosis with resultant exposure of a Nucleus multichannel implant. Successful wound management required pre- and postoperative hyperbaric oxygen in conjunction with a transposition flap closure of the scalp defect. Cochlear explantation was not necessary and rehabilitation and implant function were excellent 18 months postoperatively.