Original articleAdult cardiacSalvage of Pacemakers and Automatic Implantable Cardioverter-Defibrillators Using Dermis Grafts
Section snippets
Patients and Methods
This study was Institutional Review Board approved, and was Health Insurance Portability and Accountability Act compliant. All patients for surgery were referred from cardiologists. The primary impetus for referral was thin skin with concern about impending implant exposure and infection or pressure symptoms (n = 11), or already existing open wounds with chronic drainage (n = 2). Based on the cardiologists' experience, skin appearance in 3 patients predicted immediate skin breakdown and device
Results
In all graft procedures, there was no postoperative skin breakdown or wound infection. Exposure and extrusion were completely prevented (Table 1, Fig 1, Fig 2, Fig 3). The 2 autografted patients with preoperative open wounds and chronic drainage had no recurrence of infection or drainage. Follow-up from first surgery ranged from 3 to 68 months (mean 36.8).
Early in the series, 2 patients had repeat grafts at a second operation. In both, at surgery, the graft was visible, adherent to native
Comment
Skin erosion leading to cardiac pacing device exposure is a serious complication. Infection usually occurs, and implants can extrude. Or infection can first occur, and lead to erosion. Tsai and associates [2] studied 72 patients with infected implants and found that 42% developed erosion. Harcombe and associates [3] reported that the majority of late complications after pacemaker implantation or replacement were due to erosion and infection. At our institution with a large cardiology practice,
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Cited by (6)
Invited commentary
2011, Annals of Thoracic SurgerySalvage of Threatened Cardiovascular Implantable Electronic Devices: Case Series and Review of Literature
2018, Annals of Plastic SurgerySoft Tissue and Skin Reinforcement with Acellular Dermal Matrix to Protect Implanted Cardioverters/Defibrillators and Pacemakers
2018, Plastic and Reconstructive Surgery - Global OpenA simple technique for relocating chronic CIED leads to a subpectoral position for relief of erosion and pain
2018, PACE - Pacing and Clinical Electrophysiology