OBJECTIVE To list the complications encountered in a series of 844 consecutive patients and to evaluate the long-term difference in wound and flap problems between large and small incisions. METHODS 844 consecutive patients underwent cochlear implantation at the Sydney Cochlear Implant Centre. 212 cases were operated on prior to October 1994 using the retroauricular 'C'-shaped incision or a postauricular incision with a horizontal posterior limb. After October 1994 a new, small vertical postaural incision was used in all patients. Postoperative problems were analysed. METHODS Prospective longitudinal study of cochlear implant recipients from1984 to 2003. METHODS Tertiary care referral centre. INTERVENTION CHANGE IN INCISION FOR COCHLEAR IMPLANTATION. METHODS Causes of postoperative problems, need for reimplatation, and wound and flap problems. RESULTS 80 out of the total 844 patients underwent revision procedures for various reasons. The commonest cause of reimplantation was device failure (2.01%) or suboptimum performance of the device (2.37%). Wound and flap problems were encountered by 5 patients out of 212 (2.3%) in the first group. In comparison, 7 out of 632 patients (1.10%) from the later group experienced wound and flap problems using the new incision. CONCLUSIONS There is a reduced incidence of wound and flap problems with small skin incisions and minimal scalp mobilization. Device failure, wound and flap problems are still the commonest causes of explantation. Performance of the replacement device usually was similar to the original device and was not related to the aetiology of deafness or to the cause of explantation. These data will be useful in counselling patients for reimplantation/revision surgery.