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A Systematic Review on Complications of Tissue Preservation Surgical Techniques in Percutaneous Bone Conduction Hearing Devices

Verheij, Emmy; Bezdjian, Aren; Grolman, Wilko; Thomeer, Henricus G. X. M.

doi: 10.1097/MAO.0000000000001091

Objective: To investigate skin-related postoperative complications from tissue preservation approaches in percutaneous bone conduction device (BCD) implantations.

Data Sources: PubMed, Embase, and Cochrane Library.

Study Selection: We identified studies on BCDs including the opted surgical technique and derived complications. Retrieved articles were screened using predefined inclusion criteria. Critical appraisal included directness of evidence and risk of bias. Studies that successfully passed critical appraisal were included.

Data Extraction: Outcome measures included patient demographics, surgery time, follow-up time, and complications reported by Holgers classification.

Data Synthesis: We selected 18 articles for data extraction; encompassing 381 BCDs implanted using non-skin thinning approaches. Four studies reported an implantation technique using the punch method (81 implants), 13 studies applied the linear incision technique without soft tissue reduction (288 implants) and one study used the Weber technique (12 implants). Holgers 3 was described in 2.5% following the punch technique, in 5.9% following the linear incision technique, and in no implants following the Weber technique. One patient was mentioned having Holgers 4, skin overgrowth was reported in 6 patients, and 10 studies compared their non-skin thinning technique with a skin-thinning technique. Overall, the soft tissue preservation technique had a similar or superior complication rate, shorter surgical time, and better and faster healing, compared with the soft tissue reduction technique.

Conclusion: Tissue preservation surgical techniques for percutaneous BCDs have limited postoperative skin complication rates. Moreover, these techniques are suggested to have at least similar complications rates compared with skin-thinning techniques.

*Department of Otorhinolaryngology–Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands

Address correspondence and reprint requests to Emmy Verheij, M.D., Department of Otorhinolaryngology–Head and Neck Surgery, Utrecht Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands; E-mail:

W.G. receives unrestricted grants from Cochlear, MED-EL, and Advanced Bionics.

The authors disclose no conflicts of interest.

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