CAUSE AND REPAIR OF FLAP NECROSIS OVER COCHLEAR IMPLANT

Objective: The aim of this report was to study the cause and treatment of flap-related complications over cochlear implant. Setting: The stu dy was performed in an academic tertiary referral center. Patient: A 5 3-year-old Japanese male patient had had two retro-auricular skin inci sions for tympanomastoidectomy in the postauricular region before impl antation of a cochlear implant. He also had worn a helmet daily during work in his factory. Interventions: Corrective surgery was performed for reformation of the local blood supply to the overlying skin flap a nd reinforcement of the tissue overlying the implant by use of a super iorly based temporal muscle and fascia flap that were sutured with an inferiorly based muscle and fascia flap. Results: We successfully tran sposed the flap covering the implant without explantation of the impla nt. Conclusions: The delayed development of flap necrosis was thought to be due to pressure necrosis produced by the band in the patient's h elmet lying on the skin over the implant and to poor local blood suppl y in the postauricular area stemming from the two previous skin incisi ons for mastoid surgery performed for cholesteatoma. In those patients who wear helmets, it is important to position the cochlear implant su fficiently behind the ear and to avoid the use of a helmet.