Revision Flap Coverage Following Primary Cochlear Implant Flap Failure: A Systematic Review.

Objective: When medical management fails to solve skin flap complications following cochlear implantation (CI), same-sided reimplantation may be attempted using revision flaps that provide viable, vascularized tissue. This systematic review assesses long-term outcomes and complications of the most prevalent skin flaps in revision CI. Data Sources: PubMed, Web of Science, and Embase. Review Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, each database was queried from inception to December 15, 2024 for articles describing revision CI after skin flap failure. A qualitative synthesis of postoperative complications and long-term outcomes was employed for selected studies. Results: Of an initial 1878 abstracts screened, 12 studies met the inclusion criteria, amounting to 69 flap revisions following CI. Thirty-four revisions were performed after wound breakdown or skin necrosis at the implant site. Among the 7 studies that reported initial incision shape for their cohort, 5 used C-shaped, 1 used inverted U, and 1 used lazy S. Of the 11 articles that described their revision flap technique, 8 used a rotational flap. Three of these studies also used temporoparietal fascia flaps (TPFF). There were 9 revision flap failures (13.4%). Successful techniques included the rotational flap with either TPFF or free flap supplementation when required for coverage. Conclusion: The current data shows that skin flap revision for CI reimplantation is a feasible option following original flap failure; however, surgeons should take care to plan appropriately for each patient's unique anatomy and available viable tissue.