Double Layer Reconstruction of Exposed Cardiac Implantable Electronic Devices in Elderly Patients

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 flap...

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Bibliographic Details
Published in:	Curēus (Palo Alto, CA) Vol. 13; no. 1; p. e13024
Main Authors:	Ozkan, Burak, Albayati, Abbas, Yilmaz, Kerem C, Ciftci, Orcun, Ozin, Bulent, Uysal, Cagri A, Markal Ertas, Nilgun
Format:	Journal Article
Language:	English
Published:	United States Cureus 30-01-2021
Subjects:	Cardiac/Thoracic/Vascular Surgery Cardiology Plastic Surgery dual layer closure cardiac implantable electronic device exposition pacemaker exposition breast flap exposed cardiac implants double layer reconstruction pectoralis major muscle flap
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2168-8184 2168-8184
DOI:	10.7759/cureus.13024