Management of delayed-onset skin flap complications after pediatric cochlear implantation
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OTOLOGY
Management of delayed‑onset skin flap complications after pediatric cochlear implantation Qingling Bi1 · Zhongyan Chen1 · Yong Lv1 · Jie Luo2 · Naya Wang1 · Yuan Li1 Received: 13 March 2020 / Accepted: 31 August 2020 © The Author(s) 2020
Abstract Purpose To review delayed-onset skin flap complications associated with pediatric cochlear implantation (CI) in our institute, analyze the etiology, and explore effective treatment strategies. Methods Retrospective analyses of 811 children who had undergone cochlear implantation between January 2003 and March 2019 were performed. Twelve (1.48%) patients developed skin flap complications after CI. We present a classification of flap issues and wound histopathology following cochlear implantation. The interventions for flap problems included drug treatment, aspiration, local wound care, revision surgery, and explantation depending on the clinical situation. The temporalis myofascial reconstructive option is discussed. Results Seven subjects were cured with conservative treatment. Five cases with flap infection or necrosis underwent revision surgery, with wound closure in three cases (60%) and revision surgery with explantation in the remaining two cases (40%). Explantation ultimately led to wound healing in all cases. They all achieved excellent performance through re-implantation. Conclusion Flap complications after CI are rare but treatable. Comprehensive treatments should be developed to achieve a stable and healed wound for CI. Keywords Cochlear implant · Flap complication · Revision surgery · Temporalis myofascial flap
Introduction Cochlear implantation (CI) is the most effective technique for treatment of bilateral severe to profound sensorineural hearing loss. Since the 1960 s, almost 1 million patients have benefited from CI, and it is generally a safe procedure in experienced hands. However, as with all surgical procedures, there are complications associated with CI. The complications depend on patient condition, the type of implant device, and the surgical technique. Skin flap issues are the most common complications associated with CI. The frequency of skin flap complications reported in the * Yuan Li [email protected] Zhongyan Chen [email protected] 1
Department of Otolaryngology, China-Japan Friendship Hospital, Yinghuadong Street, Chaoyang District, Beijing 100029, China
Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, China
2
literature varies widely from 1.08 to 8.2%. [1–3] However, the definition of flap issues after CI varies between different centers. Wound infection, flap swelling, delayed-onset seroma or hematoma, skin infection, and flap necrosis have been discussed in the literature, but no systematic classification is available. [3] Loundon et al. [4] suggested that scalp lesions are theoretically more likely to occur in children, with increased risk at a younger age. The thinness of the skin, high probability of trauma, and upper respiratory infection can lead to injury of the scalp. Most per
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