ABSTRACT
Cochlear implant surgery is the standard of care for severe sensorineural hearing loss. Infection followed by implant extrusion is an infrequent complication of this surgery. The ideal treatment is explantation of the implant. However, implant removal and reimplantation is a challenging surgery and may have poor speech reception outcomes. The cost of a new implant especially in developing countries is also a deterrent. Our study dwells on the feasibility of salvaging exposed cochlear implants by a combination of pericranial flaps followed by a scalp flap cover. The study was done in a tertiary care hospital over a period of six years. Out of 303 cochlear implant surgeries, 12 patients had implant exposure and extrusion. Patients having meningitis and sepsis were excluded from the study. All patients underwent debridement and cover with double flap (Pericranial flaps and scalp rotation flap). The average operating time was 2.17 h. The surgery is technically simple with a short learning curve. It brings in rich blood supply and there is fair amount of tissue mobility. In 11 patients we were able to salvage the implant. Patients were followed for a period of 01 year post operatively. Our study suggests that salvage of infected implant should be attempted as it is feasible, durable and effective in appropriate patients.
ABSTRACT
BACKGROUND: Traumatic amputations are very prevalent in today's world. Successful rehabilitation of an amputee largely depends on how well he/she adapt to prosthesis. However, because of poor scar characteristics, these patients often complain of pain while using prosthesis. Autologous fat graft is being vastly used all over the world to improve the scar of various etiologies. However, it has been associated with unpredictable resorption rate. OBJECTIVES: We report the results of the study which was done to assess the consequences of fat grafting over scars and to see its effects on pain management in amputated stump and compare the autologous fat graft with stromal vascular filtrate (SVF)-enriched fat graft for scar remodeling and pain modulation on amputation stumps. MATERIALS AND METHODS: A prospective randomized trial was conducted from July 2014 to December 2015. A group of ten patients, who were unable to wear prosthesis due to painful amputation stump, incorporated in the study and randomly distributed in two groups. Group A of five patients (case group) was treated with autologous fat graft enriched with SVF while Group B (control group) of remaining five patients was treated with fat graft alone. The results were assessed at baseline, at 1 month, and at 6 months postoperatively using patient and observer scar assessment scale (POSAS) score. Magnetic resonance imaging (MRI) was done to compare fat content preoperatively and 6 months postoperatively. RESULTS: All ten patients reported improvement in scar characteristics, most notably in pain in both scales of POSAS score. The improvement was comparable in both groups. However, the fat content in case group was significantly more in comparison to control group when assessed 6 months postoperatively using MRI scan. CONCLUSION: Autologous fat grafting is a viable and minimally invasive solution for painful amputation stump. Enrichment of fat graft with SVF can enhance its viability over long term. This study was done as a pilot project. Hence, further long term studies with large sample size are needed to ascertain the benefits observed in this study.
