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Video

Otology/Neurotology

(A822) Flap Coverage Following Cochlear Implant Explantation: A Systematic Review

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Alexa N. Pearce, BA

    Medical Student
    UAMS Department of Otolaryngology-Head and Neck Surgery
    Little Rock, Arkansas, United States

    • Author(s)

  • Peter DA Eckard, MD

    Resident
    University of Arkansas for Medical Sciences
    Little Rock, Arkansas, United States

  • AB

    Alaina D. Baggett, BS

    Medical Student
    University of Arkansas for Medical Sciences Dept of Otolaryngology - Head & Neck Surgery
    Little Rock, Arkansas, United States

  • CS

    Carissa C. Saadi, BS

    Medical student
    University of Arkansas for Medical Sciences
    Little Rock, Arkansas, United States

  • JD

    John L. Dornhoffer, MD

    Professor and Chair
    University of Arkansas for Medical Sciences
    Little Rock, Arkansas, United States

    • Senior Author(s)

  • Robert A. Saadi, MD

    Resident Physician
    University of Arkansas for Medical Sciences
    Little Rock, Arkansas, United States

Disclosure(s):
Alexa N. Pearce, BA: No relevant relationships to disclose.
Peter DA Eckard, MD: No relevant relationships to disclose.
Alaina D. Baggett, BS: No relevant relationships to disclose.
Robert A. Saadi, MD: No relevant relationships to disclose.


Introduction: When skin flap complications occur following cochlear implantation (CI) and are not solved with medical management, same-sided reimplantation may be attempted using revision flaps that provide viable, vascularized tissue. This systematic review aims to identify the most commonly employed skin flaps in revision CI and analyze their long-term outcomes and complications.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, PubMed, Web of Science, and Embase were queried from each database’s inception to December 15, 2024 for articles describing revision CI after skin flap failure. Articles were reviewed and selected for inclusion if they described patients having experienced CI complications requiring explantation or resulting in extrusion, followed by ipsilateral reimplantation with creation of a new skin flap. A qualitative synthesis of post-operative complications and long-term outcomes was employed for selected studies.

Results: Of an initial 1878 abstracts screened, twelve studies met the inclusion criteria, amounting to 69 flap revisions following CI. Thirty-four revisions were performed after wound breakdown or skin necrosis at the implant site. Among the seven studies that reported initial incision shape for their cohort, five used C-shaped, one used inverted U, and one used lazy S. Of the eleven articles that described their revision flap technique, eight used a rotational flap. Three of these studies also used temporoparietal fascia flaps (TPFF). There were ten revision flap failures (14.4%). Successful techniques included the rotational flap with either TPFF or free flap supplementation when required for coverage, as well as the bridge flap with extended endaural incision.

Conclusions: The current data shows that skin flap revision for CI reimplantation is a feasible option following original flap failure; however, surgeons should take care to plan appropriately for each patient’s unique anatomy and available viable tissue.