Osseointegrated implants for auricular prostheses: An alternative to autologous repair.

OBJECTIVES/HYPOTHESIS: This study compares the hospital cost of osseointegrated implants for retention of an auricular prosthesis to autologous ear reconstruction. STUDY DESIGN: Retrospective review. METHODS: This study includes patients who underwent reconstruction for either congenital or acquired ear defects at Duke University Medical Center during 2009 to 2015. RESULTS: A total of nine patients had autologous repair representing nine operative ears, and 16 patients had an osseointegrated implant representing 18 operative ears (two bilateral). The average age for the autologous repair was 11.6 years with 56% male versus 40.7 years with 56% male for the osseointegrated implant patients. For autologous patients, indications for surgery were anotia/microtia in 8/9 (89%) and trauma in 1/9 (11%) versus 6/16 (387.5%) anotia/microtia, 8/16 (50%) cancer, and 2/16 (132.5%) trauma in the osseointegrated implant group. The mean number of surgeries was 3.1 for autologous repairs and 1.0 for osseointegrated repairs (mean difference confidence interval [CI]: -2.4 to -1.8, P < .001). The average cost to the hospital for an osseointegrated repair was $6,491.39 versus $10,047.93 for autologous repairs (CI: $6,496.38 to $-616.68, P = .02) CONCLUSIONS: Osseointegrated implants for retaining an auricular prosthesis has a similar cost to autologous repair of ear defects, but patients underwent an average of two more surgeries with autologous repair. Patients should be able to choose the reconstruction option that best suits their condition and preferences. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:2153-2156, 2018.

Image-Guided Placement of Osseointegrated Implants for Challenging Auricular, Orbital, and Rhinectomy Defects.

OBJECTIVES: Prosthetic reconstruction can restore the preoperative form and function after surgery for head and neck malignancies. We demonstrate the use of preoperative planning and intraoperative image guidance for placement of osseointegrated implants to restore craniofacial defects. METHODS: A retrospective review of patients with craniofacial defects treated with image-guided placement of osseointegrated prosthetic implants was performed. RESULTS: Case 1: 55-year-old male who underwent total auriculectomy with anterolateral thigh reconstruction. Case 2: 64-year-old male who required orbital exenteration and total auriculectomy with latissimus dorsi reconstruction. Case 3: 74-year-old male presented after a total rhinectomy. Cases 1 and 3 received adjuvant radiation prior to implantation. Case 2 underwent simultaneous placement of osseointegrated hearing and prosthetic implants. Computed tomography scans were used to perform preoperative planning to determine the optimal implant trajectories and sites. Complications included tissue overgrowth, delayed nonunion of implant, wound infection, and dehiscence. CONCLUSIONS: Defects following oncologic resection of head and neck malignancies can be difficult to achieve with native tissue alone. Osseointegrated implants offer an excellent means for reconstruction but can be challenging due to limited bone stock and anatomic landmarks. This can be overcome using intraoperative image guidance techniques for prosthetic reconstruction.

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.

Perspectives of women about external breast prostheses.

As many as 90% of women who have undergone mastectomy or lumpectomy for breast cancer surgery will choose to wear a breast prosthesis. To date, there has been little systematic exploration of experiences and preferences related to wearing external breast prostheses, especially with new products. For this qualitative descriptive study, 24 women were interviewed regarding their perspectives about the conventional breast prosthesis and 19 about their perspectives regarding a newly available custom-designed breast prosthesis. Women spoke about difficulties obtaining information regarding available breast prostheses options; the awkwardness of being measured and fitted for a prosthesis, especially with seemingly untrained staff; challenges in wearing an external prosthesis; and how a prosthesis can foster increased confidence, enhanced body image and self-esteem, and a sense of normalcy. All recommended that women must make an individual decision about wearing a breast prosthesis and emphasized how important it is to have information about options early in the cancer journey. The study findings can guide oncology nurses in educating women about breast prostheses.