Osseointegrated implants for replacement of absent or defective ears.

Tissue-integrated skin-penetrating implants placed in the mastoid process have been used in 94 patients for the retention of silicone rubber auricular prostheses. The surgery is performed in two stages with a 3- to 4-month interval between the first and second stage in order to establish osseointegration. During the first stage, implants made out of commercially pure titanium are placed in the bone. A gentle surgical technique is imperative in order not to damage the osteocytes, which might otherwise result in a fibrous encapsulation instead of a direct contact between implant and bone (osseointegration). The implants are handled with titanium-coated instruments only, and never by the gloved hand directly. Even minute sterile contaminants on the surface of the implant may jeopardize osseointegration. The skin penetration is performed during the second stage. This procedure includes a subcutaneous tissue reduction aimed at reducing mobility between the implant and the skin. To facilitate cleaning, the skin should be devoid of hair follicles. If necessary, a hairless skin graft from the upper arm is used. Three to four weeks after the second stage, the healing has normally reached the point at which the prosthesis can be made and attached to the implants. The frequency of adverse skin reactions around the penetration has been registered carefully. All in all, 2458 observations were made over a 10-year period. Only 3.5 per cent of these called for active treatment.