Abstract
BackgroundElderly patients with multiple comorbidities may not be candidates for cardiac implanted electronic device (CIED) explantation in cases of exposition. Excision of all unhealthy and inflamed scar tissue results in a skin defect that must be covered. Small- to moderate-sized local skin flaps and subpectoral placement of CIEDs have been described in the literature. However, these techniques still could not eliminate the risk of recurrence. In terms of minimizing the recurrence risk, we aim to increase the flap dimensions for getting better circulation and tension-free closure after subpectoral placement.Material and methodsSix patients who were operated for a dual-layer reconstruction of exposed cardiac implants between 2017 and 2020 were included in the study. All patients were referred to plastic surgery as soon as the wound biopsy culture results were negative after systemic and topical antibiotic treatment by cardiology department.ResultsNo flap loss or wound dehiscence was seen with a mean duration of 11 months follow-up. Early hematoma was encountered in a patient who was managed with irrigation and drain renewal. One patient developed suture abscess in the second month postoperatively. Knots were removed and wound healed without further intervention.ConclusionDouble layer closure of exposed cardiac implants with large breast fasciocutaneous flap after subpectoral placement of pulse generator and leads suggest durable and reliable coverage in elderly patients with multiple comorbidities.
Highlights
Cardiac implantable electronic devices (CIEDs) have been used for the management of a wide range of cardiac problems, such as bradycardia and the regulation of heart contractibility in congestive heart failure, for over 50 years [1]
Small- to moderate-sized local skin flaps and subpectoral placement of CIEDs have been described in the literature
Lead extraction may be a challenging procedure in a high-risk patient population such as the elderly with many comorbidities [7]. In this patient group, salvaging of the CIEDs is managed by dealing with bacteremia using topical/systemic antibiotics and flap coverage [8]
Summary
Cardiac implantable electronic devices (CIEDs) have been used for the management of a wide range of cardiac problems, such as bradycardia and the regulation of heart contractibility in congestive heart failure, for over 50 years [1]. Lead extraction may be a challenging procedure in a high-risk patient population such as the elderly with many comorbidities [7] In this patient group, salvaging of the CIEDs is managed by dealing with bacteremia using topical/systemic antibiotics and flap coverage [8]. The literature reports various reconstructive methods, including single- or double-layer closure with small- to moderate-sized local skin flaps and pectoralis major muscle. These methods have different recurrence and success rates [9, 10, 11]. Small- to moderate-sized local skin flaps and subpectoral placement of CIEDs have been described in the literature These techniques still could not eliminate the risk of recurrence. In terms of minimizing the recurrence risk, we aim to increase the flap dimensions for getting better circulation and tension-free closure after subpectoral placement
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