Ideal Flap Cover for the Salvage of Exposed/Infected Cochlear Implants: A Case Series and Literature Review.

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.