SALVAGING EXPOSED CARDIAC PACEMAKERS USING SUB-PECTORAL POCKET AND NEGATIVE PRESSURE WOUND THERAPY
Journal Title: IJAR-Indian Journal of Applied Research - Year 2019, Vol 9, Issue 4
Abstract
Introduction: Permanent cardiac pacemakers implanted over chest wall are prone to exposure and infection. The management of exposed pacemaker implants are controversial, and most of the time exposed devices are removed and a second device is implanted in an additional operation after days to weeks. Methods: Between Apr 2014 and Mar 2018, 24 patients were managed for exposed cardiac pacemakers. Most patients were operated within 14 days from exposure. All patients received perioperative appropriate antibiotics. In the absence of clinical signs of infection, NPWT was started for patients where there was more than one gauze piece soakage in 24 hours. Once soakage was less than 10 ml/day, implant was covered with local skin flap or placed in a sub-pectoral pocket and NPWT applied over the suture line. Mean follow-up post salvage procedure was 20 months. Results: Twenty two devices were saved. Only one grossly infected pacemaker was removed. In another patient implant got infected and exposed after four months of re-implantation and has to be removed and replaced. Conclusions: This protocol allows salvage of exposed permanent cardiac pacemaker implants even several days after exposure. A combination of NPWT and sub-pectoral muscle placement lead to salvage of the implant, saving cost and morbidity to the patient.
Authors and Affiliations
Dr (Col) D J Sharma
Keywords
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