Novel technique to manage pacemaker exposure with buried flap reconstruction: case series

Abstract

ObjectiveExposure of implantable electrical devices may increase morbidity and mortality significantly. Usually superficial infections are conservatively managed whereas invasive infections necessitate complete capsulectomy, sub-pectoral placement or implant exchange. Most commonly inadequate soft tissue coverage, soft tissue thinning and scar dehiscence over the edge of the pacemaker are the primary predisposing event. Multiple local surgical options have been described, however, with all these designs, the final scar still remains over the edge of the pacemaker and continue to have a tendency of thinning out with time. We have described a local skin flap which can be de-epithelialized and partially buried under the skin to increase the thickness over the pacemaker edge, thereby preventing further recurrence.MethodsThree patients admitted in the Cardiology Department presented with impending exposure (n=2)and exposed implant (n=1) over the edge of pacemaker with superficial infection. Local modified rotation skin flap which was de-epithelialized and partially buried under the skin to increase the thickness over the pacemaker edge was performed under local anaesthesia in all the cases.ResultsFlaps settled well in all patients with no evidence of infection, scar dehiscence and recurrence over a follow-up period of 2 years.ConclusionsThis flap technique is recommended for cases of impending pacemaker exposure resulting due to scar dehiscence over the edge and helps by addressing the predisposing factors at an initial stage. In our experience, this technique also helped to salvage exposed pacemaker with superficial infection. To our bestof knowledge this technique has not been described before in the literature.

Management of infraclavicular squamous cell carcinoma exposing a pacemaker with a fasciocutaneous flap

“…To our knowledge, only 1 other case has been reported, which was repaired using a skin graft. 6 Because of our patient’s poor skin quality and nutritional status, multiple comorbidities, and wound depth to the bone, a skin graft would have had a high potential for failure and rib exposure.…”

Vascularized Muscle Flap to Reduce Wound Breakdown During Flexible Electrode-Mediated Functional Electrical Stimulation After Peripheral Nerve Injury

“…Vascularized muscle and skin flaps have been widely used to treat exposed implants during revision surgeries. For instance, exposed pacemakers have been treated by utilizing a modified rotation skin flap over the area of scar dehiscence (51). This technique successfully prevents pacemaker infection and prevents replacement of the device completely.…”