Stee, E.H.H. van der (2017) Bone Anchored Hearing Implant : Percutaneous bone-anchored hearing implant surgery: linear incision technique with soft tissue reduction versus linear incision technique without soft tissue reduction. thesis, Medicine.
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Abstract
Background: Since the introduction of the bone-anchored hearing implant (BAHI) in 1977, soft tissue reactions and skin thickening have been recurrent problems. To prevent these, extensive soft tissue reduction has been the golden standard for years. Partly, because a smaller layer of tissue causes less friction and partly, because skin without hair is easier to clean and is therefore less likely to get infected. Due to an increased stability of implants, longer abutments could be introduced, thus providing the possibility to perform surgery without soft tissue reduction. The hypothesis is that these new abutments in combination with the surgical technique without soft tissue removal lead to less wound problems and soft tissue reactions, due to better vascularisation. Because of the longer abutments, overgrowth of the abutment is less likely, but skin thickening itself might occur more often due to increased mechanical forces. Objectives: To compare postoperative complications, soft tissue reactions and skin thickening between the linear incision technique with soft tissue removal (LIT+) to the linear incision technique without soft tissue removal (LIT-) to determine which technique should be advocated as the preferred technique. Methods: A total of 151 adult patients that received a bone-anchored hearing implant between August 2005 and October 2016 with a one-staged linear incision technique were included in this retrospective study. The LIT- was compared with the LIT+. Wound dehiscence, implant loss, soft tissue reactions (graded using the Holgers scale) and skin thickening were recorded. Results: A total of 91 patients were operated on using the LIT+ with a median follow-up of 64.0 months (interquartile range (IQR) 33.0-99.0). The LIT- group contained 60 patients and the median follow-up was significantly shorter: 7.5 months (IQR 2.3 – 17.5). Wound dehiscence was seen in 29 patients (31.9%) of the LIT+ group of which two needed surgical intervention. In the LIT- group no wound dehiscence was seen. This difference was significant (p<0.001). In the LIT+ group four cases of implant loss were recorded (4.4%), all after at least six years of follow-up. In the LIT- group 16 implants (26.7%) showed a soft tissue reaction in the first two years of follow-up, of which 2 (3.3%) were graded as Holgers ≥ 2. In the LIT+ group there were 28 (30.8%) soft tissue reactions of which 16 (17.6%) adverse soft tissue reactions. These differences were not significant (p=0.455 and p=0.103). Skin thickening was seen in 7 (7.7 %) of the implants in LIT+ group and 12 (20.0 %) of the LIT- group in the first two years of follow up (p<0,001). In both groups skin thickening in need of treatment was seen in 5 implants (LIT- 8.3% and LIT+ 5.5%). This difference was also significant (p=0.018), but treatment was successful in all cases. Conclusion: The LIT- has a significantly higher rate of skin thickening, whereas the LIT+ has a significantly higher rate of wound dehiscence. Both complications are no major drawbacks. Based on the results of this study, we can say that both techniques are successful and safe, but we cannot advocate one technique as the preferred technique. However, combined with the advantages of the LIT- recorded in other studies, the LIT- seems superior.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Bom, dr. S.J.H. and Location: Deventer Ziekenhuis and Department: Ear-Nose and Throat Surgery |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:00 |
| Last Modified: | 25 Jun 2020 11:00 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2063 |
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