Osseointegration and Skin Thinning
Lanis and Hultcrantz (2013) report that osseointegrated implants (bone-anchored hearing systems) have historically involved a two-step procedure, the second step of which included skin-thinning at the operation site. Recently, a one-step procedure has been used in adults that has been shown to be cost effective and has allowed earlier hearing habituation.
Lanis and Hultcrantz report 23 children implanted with skin thinning (average age at time of surgery was 7 years) and 10 children without skin thinning (average age at time of surgery was 5.3 years). The children operated on without skin thinning were each operated on after late-2010. Therefore, the mean follow-up time for the children who had skin thinning is longer (6.4 years) and the average follow-up time for children who did not receive skin thinning is shorter (1.3 years). All children were under general anesthesia at time of implantation and each was operated on by the same surgeon.
The authors state that the "the omission of skin thinning is beneficial for children…." Benefits include lesser surgical and healing time, improved cosmetic appeal, shorter time for "loading" the processor (i.e., osseointegration time), no increase in infections, no major numbness and no flap necrosis, as well as fewer complications and fewer hospital visits.
For More Information, References, and Recommendations
Lanis A, Hultcrantz M. (2013) Percutaneous Osseointegrated Implant Surgery Without Skin Thinning in Children – A Retrospective Case Review. Otology & Neurotology 34(4):715-722.
McDermott AL, Williams J, Kuo M, Reid A, Proops D. (2009) The Birmingham Pediatric Bone-Anchored Hearing Aid Program: A 15-Year Experience. Otology and Neurotology 30(2):178-183.