Autologous fat grafting as a minimally invasive technique to avoid cochlear implant extrusion

Abstract

Objectives

Infection of the skin-muscle flap is one of the most severe risks of cochlear implantation. The aim of this paper is to describe a novel and minimally invasive procedure to avoid cochlear implant (CI) extrusion.

Methods: A 79-year-old woman with severe comorbidities developed a pressure injury of the skin-muscle flap overlying the CI receiver/stimulator (R/S) nine years after surgery. Skin thinning and failure of conventional pressure injury management led the patient to a high risk of CI extrusion. Therefore, she underwent a single procedure of autologous fat grafting under local anesthesia to increase scalp thickness and vascularization over the CI R/S.

Results: Within one month, complete healing of the pressure injury was observed, and the patient was able to safely use her CI. No further signs of infection and skin deterioration were detected at the 15-months follow-up.

Discussion: Fat grafting has been proven to promote neoangiogenesis and tissue regeneration. To the best of our knowledge, this is the first report of fat grafting utilized in the skin-muscle flap area to avoid incipient CI R/S extrusion.

Conclusion: The described case demonstrates the efficacy of this salvage procedure to avoid major surgery and the additional costs related to CI reimplantation.

Keywords:

• Fat grafting
• Cochlear implant
• Receiver/stimulator extrusion
• Tissue regeneration
• Neoangiogenesis

Acknowledgements

We thank Dr Luigi Flaminio Ghilardini for technical editing and proofreading.

Disclaimer statements

Contributors Mirko Aldè, substantial contributions to the conception, design, acquisition, interpretation of data for the work; drafting the work; final approval of the version to be published; agreement to be accountable for all aspects of the work; Riccardo F. Mazzola, revising the work critically for important intellectual content; giving final approval of the version to be published; agreement to be accountable for all aspects of the work; Umberto Ambrosetti, revising the work critically for important intellectual content; giving final approval of the version to be published; agreement to be accountable for all aspects of the work; Federica Di Berardino, substantial contributions to the acquisition, interpretation of data; giving final approval of the version to be published; agreement to be accountable for all aspects of the work; Giovanna Cantarella, substantial contributions to the acquisition, interpretation of data; revising the work critically for important intellectual content; giving final approval of the version to be published; agreement to be accountable for all aspects of the work.

Funding None.

Conflicts of interest None.

Ethics approval This study was approved by the Institutional Review Board of Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.

Additional information

Notes on contributors

Mirko Aldè

Mirko Aldè is a Medical Doctor at Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Italy. His primary interests include Pediatric Ear Disorders, Otology and Childhood Deafness.

Riccardo Francesco Mazzola

Riccardo F. Mazzola is a Medical Doctor, Assistant Professor and Plastic Surgeon at Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. His primary interests include Cleft Lip and Palate, Head and Neck reconstruction, Nasal Reconstruction, Rhinoplasty and the History of Plastic Surgery.

Umberto Ambrosetti

Umberto Ambrosetti is a Medical Doctor, Associate Professor and Researcher of the University of Milan, Italy. He has extensive experience in all aspects of otologic surgery.

Federica Di Berardino

Federica Di Berardino is a Medical Doctor at Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Associate Professor and Researcher of the University of Milan, Italy. Her primary interests include Cochlear Implants, Vestibular Disorders and Childhood Deafness.

Giovanna Cantarella

Giovanna Cantarella is a Medical Doctor, Associate Professor and Director of the School of Specialization in Audiology/Phoniatrics of Milan University, Department of Otolaryngology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milan, Italy. She is author of more than 200 presentations in national /international conferences.