Linear Versus Curved Incision for Transcutaneous Bone Conduction Implants: Comparative Scar Assessment

In some patients with conductive or mixed hearing loss, or single-sided deafness, bone conduction implants (BCIs) offer an effective treatment; and scar appearance is a relevant factor in the overall outcome.

To compare scar appearance and alopecia between linear and curved scalp incisions in patients undergoing transcutaneous BCIs surgery.

An observational, cross-sectional study was conducted at a tertiary referral center in patients who underwent transcutaneous BCI. Postoperative follow-up period was between 6m to 3y. Scar evaluation was performed using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). Alopecia was defined as absence of hair follicles within 2 mm of the incision line. Statistical comparisons between linear and curved incisions groups were conducted, as well as multivariate analysis with logistic regression models.

Eighty-four cases were analyzed: 28 underwent linear incisions and 56 underwent curved incisions. Patients reported significantly better scar appearance with linear incisions in POSAS, p  = 0.035. Alopecia occurred less frequently among patients who received the Bonebridge implant (OR = 0.113; 95% CI: 0.027-0.478; p  = 0.003). No statistically significant differences were found in observer assessment of POSAS or VSS scores.

Linear incisions may offer advantages in scar appearance with transcutaneous BCIs. Certain scar characteristics may also be influenced by the type of device and the surgical approach required for its placement, making it challenging to isolate this effect from that attributed solely to type of incision. These results highlight the need to consider both cosmetic factors and auditory outcomes in surgical planning.