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Reinforcement of a Subcutaneous Pocket for Implantable Cardioverter Defibrillator Insertion Using Acellular Dermal
Jun Ho Choi1, Ho Jun Lee1, Kwang Seog Kim1
1Department of Plastic and Reconstructive Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea.
Journal of Clinical Medicine
|May 11, 2024
Summary
Thinning chest wall pockets in pediatric patients pose an implantable cardioverter-defibrillator (ICD) exposure risk. Strengthening the pocket with acellular dermal matrix (ADM) effectively prevents complications.
Area of Science:
- Cardiology
- Biomaterials Science
- Pediatric Surgery
Background:
- Pediatric patients undergoing chest wall implantations, such as implantable cardioverter-defibrillators (ICDs), are susceptible to device exposure.
- Thinning of the subcutaneous pocket increases the risk of ICD complications, including infection.
Observation:
- An 8-year-old boy required ICD replacement due to pocket thinning and exposure risk five months post-implantation for long QT syndrome.
- Initial ICD removal and pocket closure were performed to mitigate infection risk.
Findings:
- A novel surgical approach involved creating a new suprafascial pocket reinforced with an acellular dermal matrix (ADM) to prevent ICD protrusion.
- Postoperative follow-up for one year showed successful ADM engraftment with no observed complications.
Implications:
- Acellular dermal matrix (ADM) reinforcement of subcutaneous pockets is a viable strategy to prevent ICD protrusion and rupture in pediatric patients.
- This technique enhances the durability of ICD pockets, reducing the risk of device exposure and associated infections.
