Double Layer Reconstruction of Exposed Cardiac Implantable Electronic Devices in Elderly Patients.
breast flap
cardiac implantable electronic device exposition
double layer reconstruction
dual layer closure
exposed cardiac implants
pacemaker exposition
pectoralis major muscle flap
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
30 Jan 2021
30 Jan 2021
Historique:
entrez:
5
2
2021
pubmed:
6
2
2021
medline:
6
2
2021
Statut:
epublish
Résumé
Background Elderly 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 methods Six 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. Results No 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. Conclusion Double 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.
Identifiants
pubmed: 33542888
doi: 10.7759/cureus.13024
pmc: PMC7849925
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e13024Informations de copyright
Copyright © 2021, Ozkan et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Ann Plast Surg. 2007 Jul;59(1):26-9; discussion 30
pubmed: 17589255
Pacing Clin Electrophysiol. 2004 Jun;27(6 Pt 1):779-82
pubmed: 15189534
J Thorac Cardiovasc Surg. 2016 Nov;152(5):1450-1451
pubmed: 27436094
Ann Plast Surg. 2012 Sep;69(3):292-5
pubmed: 21734547
Europace. 2010 Jan;12(1):64-70
pubmed: 19910314
Ann Plast Surg. 2014 Feb;72(2):188-92
pubmed: 23241772
Pacing Clin Electrophysiol. 1996 Apr;19(4 Pt 1):437-42
pubmed: 8848391
J Card Surg. 1996 May-Jun;11(3):180-6
pubmed: 8889877
Am Heart J. 1991 Mar;121(3 Pt 1):881-8
pubmed: 2000756
Aesthet Surg J. 2016 Mar;36(3):297-309
pubmed: 26843099
Plast Reconstr Surg. 2017 Sep;140(3):427-431
pubmed: 28841597
Plast Reconstr Surg Glob Open. 2015 Apr 07;3(3):e343
pubmed: 26034650
Int J Clin Pract. 2010 Jul;64(8):1140-7
pubmed: 20642712
Pacing Clin Electrophysiol. 1999 Sep;22(9):1348-57
pubmed: 10527016
Br J Plast Surg. 1977 Jul;30(3):231-4
pubmed: 329933
Cureus. 2020 Jun 26;12(6):e8849
pubmed: 32626631
Br J Plast Surg. 1979 Oct;32(4):281-4
pubmed: 534791
Plast Reconstr Surg. 2013 Nov;132(5):1319-1328
pubmed: 23924649
Circulation. 2011 Mar 22;123(11):e378-80
pubmed: 21422393
Europace. 2013 Apr;15(4):541-5
pubmed: 23015633
Ann Plast Surg. 2018 Sep;81(3):340-343
pubmed: 29781854
Pacing Clin Electrophysiol. 1999 May;22(5):711-20
pubmed: 10353129
Int Wound J. 2017 Apr;14(2):385-398
pubmed: 27170231