This paper is not the first, and is unlikely to be the last, to look at a variation on the current technique for inserting the percutaneous titanium bone-anchored component of a bone conduction hearing device. In less than a decade, we have moved away from the traditional technique of raising and thinning a skin flap with a dermatome, to the use of a simpler linear incision (approx. 3cm). This is often accompanied by soft tissue reduction. This paper utilises the Hultcrantz method of linear incision with soft-tissue preservation as the test group. This industry-sponsored study, from the Nijmegen Otology Group, has looked at postoperative three-year outcomes for 50 matched case (linear incision + soft tissue preservation) and control (linear incision + soft tissue reduction) patients, focusing on postoperative skin sensibility and numbness.

Secondary outcomes were implant stability over time, adverse skin reactions, skin height, implant survival, the need for revision surgery, and scar assessment. Only one patient was lost to follow-up. The results of the primary outcome, somewhat unsurprisingly, reveal significantly better skin sensation in the soft tissue preservation group in the first year. There were, however, adverse skin reactions in 36% versus 12% in the control group. All are reported to have resolved with topical treatment.

There were no abutment extrusions in either group. There were no statistically significant differences observed in any of the secondary outcomes. At three-year follow-up there was less difference between the two groups for any of the outcomes. There are certainly difficulties with this study as the outcome of measuring sensation cannot be blinded as there is a different appearance, and the test group had fewer initial postoperative visits than the control group. The proposed advantage of shorter operating time and comparable long-term outcomes of a linear incision with soft tissue preservation need to be weighed with the clinical burden of skin complications in the short term postoperatively with that surgical technique. 

Three-Year Clinical and Audiological Outcomes of Percutaneous Implants for Bone Conduction Devices: Comparison Between Tissue Preservation Technique and Tissue Reduction Technique.
Kruyt IJ, Kok H, Bosman A, et al.
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Aileen Lambert

Great Ormond Street Hospital, London, UK.

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