Hariharan N C, Muthukumar R, Sridhar R, Shankari B, Valarmathy V S
Department of Plastic Surgery, Institute of Non Communicable Diseases and Govt. Royapettah Hospital, V-1, Sri Mahalakshmi Enclave, 24, Gandhi Road, Gill Nagar, Chennai, 600014 India.
Upgraded Institute of Otorhinolaryngology, Madras Medical College, Chennai, India.
Indian J Otolaryngol Head Neck Surg. 2020 Sep;72(3):292-296. doi: 10.1007/s12070-019-01764-1. Epub 2019 Nov 12.
With an increase in the number of cochlear implant surgeries there is bound to be an increase in the number of complications. A dreaded problem in any implant procedure is the implant exposure and infection. Explantation of the implant leads to an unpleasant situation to the patient and the surgeon owing to the high cost of the device. There are reports in the literature favouring the mandatory relocation or removal of the infected implants. On the other hand, there are convincing reports of implant salvage using skin, muscle or fascial flaps. In this paper we have analysed a series of cases referred to us from the departments of E.N.T for the management of implant exposure/infection. We have also reviewed similar case series reported in the literature. From 2014 to 2017 we operated six cases of exposed cochlear implant. We salvaged the implant in five cases, where we could do two layer coverage consisting of the inner temporoparietal fascial flap and outer scalp skin flap. In one case where the temporoparietal fascial flap could not be done as superficial temporal vessels were found to be injured in the previous surgery, the implant was removed due to persistent infection. All these cases were administered appropriate antibiotics for a minimum period of 3 weeks. Early double layer closure with inner temporoparietal fascial flap and outer scalp rotation flap coupled with appropriate antibiotics can salvage an infected, exposed implant.
随着人工耳蜗植入手术数量的增加，并发症的数量必然会上升。在任何植入手术中，一个可怕的问题就是植入物暴露和感染。由于设备成本高昂，取出植入物会给患者和外科医生带来不愉快的情况。文献中有报告支持对感染的植入物进行强制性重新定位或取出。另一方面，也有令人信服的关于使用皮肤、肌肉或筋膜瓣挽救植入物的报告。在本文中，我们分析了一系列从耳鼻喉科转诊至我们科室以处理植入物暴露/感染的病例。我们还回顾了文献中报道的类似病例系列。2014年至2017年，我们对6例人工耳蜗暴露病例进行了手术。我们在5例病例中挽救了植入物，在这些病例中，我们采用了由颞顶筋膜内瓣和头皮外瓣组成的双层覆盖。在1例病例中，由于发现颞浅血管在前一次手术中受损而无法进行颞顶筋膜瓣手术，因持续感染而取出了植入物。所有这些病例都至少使用了3周的适当抗生素。早期采用颞顶筋膜内瓣和头皮旋转外瓣进行双层闭合，并结合适当的抗生素，可以挽救感染且暴露的植入物。
