Evaluating the efficacy of a novel periosteal flap in cochlear implantation: a retrospective surgical audit at a tertiary teaching hospital

Abstract

Abstract Background This research aimed to critically evaluate the safety and reliability of a new periosteal flap technique in cochlear implantation through a comprehensive surgical audit. A surgical audit was conducted on a cohort of 39 patients who underwent cochlear implantation at a tertiary teaching hospital from July 2020 to September 2021. The novel periosteal flap technique was utilized in all cases. Patients were followed up for a period ranging from 2 to 12 months. For comparison, outcomes were assessed by comparing 51 children who had undergone cochlear implant surgery between July 2017 and June 2019, utilizing the anteriorly based palva flap. A scoring system was employed to evaluate various aspects, including ease of surgical exposure, flap maneuverability, ease of closure after device fixation, immediate postoperative complications (up to 24 h), and delayed complications (up to 30 days). Scores ranging from 1 (fair assessment) to 4 (excellent assessment) were assigned, with a maximum score of 18 indicating optimal outcomes. Results The comparison between the two groups revealed a reduced incidence of emissary vein injury and easier wound closure after device fixation in the novel periosteal flap group (p = 0.000). The mean total scores were significantly higher in the novel periosteal flap group, indicating superior outcomes. Only 2 out of 39 children with the novel flap experienced minor skin color changes during the initial postoperative period, which resolved within approximately 7 days. Major complications such as wound infection, hematoma, or device migration were not observed with the new periosteal flap. Furthermore, no flap revisions were required. Conclusions The novel and innovative periosteal flap demonstrated both safety and reliability in cochlear implantation procedures. This well-vascularized and robust flap offered effective device coverage with minimal flap-related complications. Its time-saving nature further enhances its clinical utility. Additional validation from different medical centers would further corroborate the advantages of this easily implemented periosteal flap technique. Level of evidence Level 3.

Keywords

• Cochlear implantation
• Periosteal flap
• Surgical technique
• Device coverage
• Flap-related complications
• Hearing loss