Osseointegrated implants for auricular defects: operative techniques and complication management.

OBJECTIVE: Auricular defects are challenging to reconstruct with native tissue. We describe operative techniques and complication management for patients undergoing osseointegrated implants for auriculectomy defects and microtia. SETTING: Tertiary referral center. PATIENTS: All patients at Duke University Medical Center with auricular defects treated with osseointegrated implants for prosthetic (OIP) auricles from January 1, 2010, until September 16, 2013. INTERVENTIONS: Osseointegrated implantation for auricular defects. MAIN OUTCOME MEASURE: Description of operative techniques, complications, and complication management. RESULTS: Sixteen patients met inclusion criteria. Five patients had microtia and atresia. Two of these patients had bilateral microtia and atresia and underwent bilateral simultaneous implantation of both OIP and osseointegrated hearing implants (OHIs). Two other microtia/atresia patients underwent simultaneous unilateral OIP and OHI. Eleven patients had unilateral defects from either trauma or skin cancer resection. Three patients received adjuvant radiation before implantation. Complications included tissue overgrowth requiring revision surgery (two patients), inadequate bone stock requiring split calvarial bone graft and later implantation, loss of implant secondary to osteoradionecrosis requiring hyperbaric oxygen therapy, and skin infection requiring antibiotic therapy. CONCLUSION: Reconstruction of auriculectomy defects and microtia is difficult to accomplish using native tissue. Complications are common, and these complications can have devastating consequences on the final result. Osseointegrated implantation offers an outstanding alternative for reconstructing these defects. We describe our multidisciplinary team approach, examine operative techniques, and focus on the unique challenges of simultaneous and bilateral simultaneous OIP and OHI implantation.