Management of Late Extrusions of Cochlear Implants

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Objectives: The study aimed to identify the important principles in repairing and preventing delayed cochlear implant extrusions.

Study Design: The study design was a retrospective, international database review and three case presentations from the authors' local database.

Setting: The study was conducted at a tertiary referral center.

Patients: Cochlear Corporation's database of 8,665 implantees in North and South America and Israel was studied. A subset of this database, consisting of 74 patients implanted through the Louisiana State University/Eye, Ear, Nose and Throat (LSU/EENT) project, is analyzed separately and provides the case reports.

Intervention: Surgical repair of skin breakdown over the edge of three cochlear implants using a two-layer, pericranial and scalp rotation flap technique was performed.

Main Outcome Measures: A functioning cochlear implant with a healthy skin covering was measured.

Results: The three LSU/EENT cases reported here used a pericranial flap to repair the capsule of the implant and a large scalp rotation flap to repair the skin defect. A novel pericranial tuck-under technique is especially useful for the Nucleus Mini-22 implant. With this technique, the authors have had a 100% success rate (3 of 3). The basic principles used in the repair and in the initial implant surgery are discussed.

Conclusions: The following conclusions were reached: 1) avoid skin closure lines parallel to the cochlear implant edge that are closer than 1.5 cm from the implant edge; 2) excise enough skin and scar around the dehiscence to achive principle 1; 3) design a large, well-vascularized anterior- or posterior-based scalp rotation flap to cover this defect; and 4) close the implant capsule defect with a well-vascularized pericranial flap.

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