The temporoparietal fascia flap for coverage of cochlear reimplantation following extrusion

Karimnejad, Kaveh; Akhter, Asad S.; Walen, Scott; Mikulec, Anthony A.

doi:10.1016/j.ijporl.2017.01.020

Cited by 23 publications

(11 citation statements)

References 13 publications

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“…The patients in the present series have varying comorbidities and all have significant reasons for poor wound healing, with radiation therapy representing a major contributor. While no children underwent TPF flap in our series, this flap can also be performed in children, as reported by Karimnejad et al 13 In this report, 2 pediatric patients underwent explantation followed by reimplantation and TPF flap. This technique can be used in device salvage, as well as with explantation with re-implantation strategies.…”

Section: Discussionsupporting

confidence: 61%

“…However, the use of the TPF flap for cochlear implant soft tissue complications has been described in only 2 separate case reports. 12,13 Here, we present a series of patients having undergone cochlear device implantation with both acute or delayed major overlying soft tissue complications successfully managed with a TPF flap as an integral part of their treatment plan.…”

Section: Introductionmentioning

confidence: 99%

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The Temporoparietal Fascia Flap is an Effective Strategy for Cochlear Implant Wound Coverage

Leonhard

Roche

Wieland

et al. 2019

Ann Otol Rhinol Laryngol

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Objective: To report the rate of major soft tissue complications after cochlear implantation and to describe the use of the temporoparietal fascia (TPF) flap for such complications. Study Design: Retrospective case series. Setting: Tertiary care, University Hospital. Subjects and Methods: Chart review of all patients who underwent cochlear device implantation over a 5-year period to identify patients and to determine the rate of soft tissue complications. Five patients with major soft tissue complications underwent TPF flap with device salvage or explantation/reimplantation. Results: The rate of major skin complications was 6 out of 281 (2.1%) over 5 years, with 5 patients undergoing TPF flap. The average follow-up was 25.8 months (range, 5-58 months). TPF flap represented the definitive, successful solution for all 5 patients. One postoperative hematoma occurred after TPF flap, with no long-term sequelae. The average hospital length of stay was 2.2 nights (range, 1-5 nights). One patient required IV antibiotics for 4 weeks; the remaining patients were treated with a postoperative course of oral antibiotics. The original device remained in place for 4 patients, while one case required device explantation and staged re-implantation. Post-TPF flap hearing results were equal to if not superior to their preoperative results. Conclusion: Major soft tissue complications following cochlear device implantation are rare. The temporoparietal fascia flap is an excellent option for reconstruction of device site soft tissue dehiscences when local wound care and primary closure are not sufficient, and can potentially prevent explantation of a functional implant.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

The Temporoparietal Fascia Flap is an Effective Strategy for Cochlear Implant Wound Coverage

Leonhard

Roche

Wieland

et al. 2019

Ann Otol Rhinol Laryngol

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“…Advances in implant design and surgical technique including lower profile devices, avoidance of scalp thinning, and smaller skin incisions have lessened these extrusions . Recognition of difficult cases including those patients with prior mastoid surgery or radiation has improved with appropriate alteration of technique to lessen extrusion …”

Section: Discussionmentioning

confidence: 99%

“…To avoid these complications, the CI surgical site requires well‐vascularized, healthy tissue to reconstruct and protect the cochlear implant and surrounding structures. In the event of hardware extrusion, options for locoregional reconstruction include postauricular pedicled skin flaps, rotational scalp flaps, pericranial flaps, pedicled temporalis muscle flaps, and temporoparietal fascia flaps . Staged options including explantation with reimplantation and tissue expansion are available, but may lead to unavoidable and potentially stressful, prolonged periods of deafness for the patient .…”

Section: Introductionmentioning

confidence: 99%

Microvascular free tissue transfer and cochlear implants: A case series and literature review

et al. 2019

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Objective: The use of microvascular free tissue transfer (MVFTT) for defects of the scalp and lateral temporal bone in patients with cochlear implants (CI) is uncommon. Herein, we report our experience with the utility, indications, and outcomes for MVFTT in patients with cochlear implants.Methods: A retrospective review of patients at our institution from September 2016 to December 2017 identified subjects with coexistent cochlear implant and ipsilateral MVFTT of the lateral temporal bone or scalp. Information including demographics, indication for MVFTT, timing of CI and MVFTT, donor site, and previous radiation to the head and neck was collected. To assess the current literature on MVFTT in CI patients, a MEDLINE search was performed using key search terms.Results: Two patients with cochlear implants and MVFTT of the ipsilateral temporal bone or scalp were identified. One patient underwent MVFTT for advanced device extrusion with stable audiometric parameters rather than locoregional reconstruction or device explantation. The second patient had primary cochlear implantation at oncologic lateral temporal bone resection (LTBR) and MVFTT for locally advanced squamous cell carcinoma and concurrent profound sensorineural hearing loss (SNHL). A literature review identifies MVFTT as an option for advanced device extrusion, treatment of osteoradionecrosis, and reconstruction after primary oncologic surgery.Conclusion: MVFTT is an important reconstructive tool for patients with functional, exposed cochlear implants. Cochlear implantation for severe to profound SNHL should be considered at the time of primary oncologic surgery and MVFTT of the lateral temporal bone or scalp.

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“…The causes of wound breakdown include an incorrect direction of the incision upon implantation, infection, skin flap necrosis, and external pressure on the implant site [1]. Cochlear implant extrusion can be reconstructed using various methods, including but not limited to primary closure, postauricular pedicled flaps, scalp rotational flaps, pericranial flaps, anterolateral thigh flaps, and pedicled temporalis muscle flaps [2].…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of a scalp defect due to cochlear implant device extrusion using a temporoparietal fascia flap and a split-thickness skin graft from the scalp

Kang

Lee

Suh

et al. 2019

Arch Craniofac Surg

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Cochlear implant extrusion, which is a common complication of cochlear implants, is generally repaired by a well visualized soft-tissue flap. A 61-year-old female patient with a medical history of schizophrenia who had a skin ulcer that caused cochlear implant extrusion, but that would be a stronger statement was referred to our department for removal of the implant and reconstruction of the resultant scalp defect. Accordingly, the broad defect was covered via rotation of a temporoparietal fascia flap (TPFF) using the superficial temporal artery, with the pedicle in the preauricular region as the pivot point. Coverage of TPFF was achieved with a split-thickness skin graft using the scalp as the donor site, which led to a quick recovery after the operation and satisfactory results in terms of aesthetics. This case suggests that a TPFF might be used as a flexible flap with low donor site morbidity for reconstructing cases of cochlear implant extrusion accompanied by a large full-layer scalp defect.

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The temporoparietal fascia flap for coverage of cochlear reimplantation following extrusion

Cited by 23 publications

References 13 publications

The Temporoparietal Fascia Flap is an Effective Strategy for Cochlear Implant Wound Coverage

The Temporoparietal Fascia Flap is an Effective Strategy for Cochlear Implant Wound Coverage

Microvascular free tissue transfer and cochlear implants: A case series and literature review

Reconstruction of a scalp defect due to cochlear implant device extrusion using a temporoparietal fascia flap and a split-thickness skin graft from the scalp

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