Pediatric and adolescent bone-anchored implant. Skin changes and complications

Objective: To assess the contributing factors for development of skin changes and local complications in the pediatric and adolescent population who underwent bone-anchored implantation (BAI). Methods: Retrospective chart review of pediatric and adolescent patients (age 0–17 years) who underwent BAI for mixed hearing loss, conductive hearing loss, and single-sided deafness, at a tertiary care academic center. Demographic, clinical, implant type and surgical variables were collected and analyzed to identify their contribution to the development of skin changes and local complications. Results: Thirty-nine BAI surgeries were performed in 28 subjects during the review period. The mean age of implantation was 10.5 ± 3.4 years (5–16 years). Skin changes and local complications occurred in 61.5% (24/39) of BAIs performed. In total, 75% (18/24) were attributed to local complications, and 25% (6/24) to skin changes. Revision surgery was required in 41.0% (16/39) of cases. The mean age upon revision with either skin changes or local complications, local complications alone, and skin changes alone was 14.6 ± 3.3 years (7.25–19), 13.4 ± 4.0 years (7.3–17), and 16.1 ± 1.2 years (13.8–17) respectively with no difference between the groups. Among implants with skin changes and local complications the abutment survival was found to be 33.3% at 6.75 years following implantation. No significant difference of demographic and clinical factors was noted when looking at cases with and without skin changes and local complications. Higher rates of skin changes and local complications were noted in two-stage techniques, non-linear incision and the use of absorbable sutures. Conclusion: Fewer skin changes/local complications were observed with linear incision/punch technique, single stage, and non-absorbable skin sutures. Abutment survival with skin changes and local complications plateaus at 6.75 years following implantation. The potential need for revision surgery and longer abutment replacement during puberty, presumably when scalp soft tissue thickens, should be considered prior to initial implantation of younger children, with information given to their care givers