An effective technique for salvage of cardiac-related devices

Millions of patients require implantable cardiac devices for management of cardiac dysrhythmias. These devices are susceptible to erosion, exposure, or infection and plastic surgeons are consulted when salvage is required. As of yet, an anterior muscle-splitting approach to effectively and safely relocate the device into the subpectoral position has not been described in the plastic surgery literature. The authors retrospectively reviewed the charts of 7 patients who required repositioning of cardiac devices. Indications for repositioning included exposure, erosion, infection, hematoma at the time of primary placement (3), and one cosmetic revision. All patients were treated with subpectoral repositioning of the device into the subpectoral space via an anterior muscle-splitting approach. Six of 7 patients (86%) achieved successful long-term repositioning in the subpectoral position without recurrent exposure or hematoma and with good cosmetic results. One patient who had a prior history of multiple failed device placements required reoperation due to recurrent infection. The anterior muscle-splitting technique proposed by the authors for defibrillator or pacemaker salvage is a feasible technique with promising results. Plastic surgeons should be aware of this simple and effective approach.