[Vacuum-assisted treatment of severe pacemaker pocket infection]

After pacemaker implantation or replacement, infection of the pacemaker pocket is observed in approximately 1% of patients. Sometimes the patient also develops extended ulcers with infiltration of muscle and connective tissue next to the local infection. In the worst case, there is a systemic inflammation with lead vegetations and endocarditis. We report the case of a patient, in whom a two-chamber pacemaker was implanted in 2001. In the following years the pacemaker was treated four times including imminent perforation the skin level. At the time of accommodation there were local and systemic signs of inflammation and bacterial vegetations at the ventricular lead, and explantation of the pacemaker and rehabilitation of the pocket was indicated. We removed the pacemaker, leads and the complete ulcer. The surgical removal of the complete ulcer created a large pocket in front of the Musculus pectoralis without the possibility of primary closure; thus, we performed vacuum-assisted reduction of this cavity in stages combined with continuous removal of secretion and necrotic tissue. The goal of this treatment was complete closure of the cavity with avoidance of infection, scars or reduced functionality of the muscle.