Haberkamp T J, Schwaber M K
Department of Otolaryngology and Human Communication, Medical College of Wisconsin, Milwaukee.
Ann Otol Rhinol Laryngol. 1992 Jan;101(1):38-41. doi: 10.1177/000348949210100111.
Skin flap complications are the most commonly reported problems in cochlear implant surgery when the anteriorly based C-shaped flap is used for the incision. If the prosthesis is exposed by flap necrosis, local skin flaps may be used to obtain coverage. Unfortunately, the long-term viability of such flaps may be compromised by the pressure exerted by the transmitter. Two cases of flap necrosis severe enough to expose the prosthesis have been successfully managed by relocating the device to a position superior to the auricle, under healthy skin. In one case the receiver was removed owing to infection and reimplanted at a later date. In this case, the electrode array was left in place at explantation in order to stent the cochlea. The surgical techniques and flap designs for this procedure are presented. No further surgical complications have developed in either case. The devices are performing well for both patients at this time. We have found relocation of the implant a useful technique in the management of major flap necrosis. This technique may also be useful to prevent flap necrosis should excessive flap thinning occur during the implant operation.
当使用基于前方的C形皮瓣进行切口时，皮瓣并发症是人工耳蜗植入手术中最常报告的问题。如果假体因皮瓣坏死而暴露，可以使用局部皮瓣进行覆盖。不幸的是，这种皮瓣的长期存活可能会受到发射器施加的压力的影响。有两例皮瓣坏死严重到足以暴露假体的病例，已通过将设备重新安置到耳廓上方健康皮肤下的位置成功处理。在一例中，接收器因感染而被移除，后来重新植入。在这种情况下，为了支撑耳蜗，电极阵列在取出时留在原位。本文介绍了该手术的外科技术和皮瓣设计。两例均未出现进一步的手术并发症。此时，两个患者的设备运行良好。我们发现将植入物重新定位是处理严重皮瓣坏死的一种有用技术。如果在植入手术期间皮瓣过度变薄，该技术也可能有助于预防皮瓣坏死。
