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The exposed cardiac pacemaker. Treatment by subfascial pocket relocation
The Journal of Thoracic and Cardiovascular Surgery
|January 1, 1985
Summary
Relocating exposed pacemakers to deeper subfascial planes promotes healing. This surgical technique, avoiding complete pacemaker replacement, proved effective in patients with skin erosion over implanted pulse generators.
Area of Science:
- Cardiology
- Infectious Disease
- Surgical Innovation
Background:
- Skin erosion and exposure of chronically implanted pacemakers pose significant clinical challenges.
- Previous implantation sites included subcutaneous, subpectoral, and submammary locations.
Purpose of the Study:
- To evaluate the efficacy of relocating pacemaker pulse generators to deeper subfascial planes in patients with exposed devices.
- To determine factors influencing the healing of exposed pacemaker sites.
Main Methods:
- Ten patients with skin erosion and exposed pacemakers underwent primary or secondary relocation of the pulse generator.
- Pulse generators were moved to deeper subfascial planes.
- Bacteriologic studies were performed, and antibiotic use was noted.
Main Results:
- Pacemakers relocated primarily to subfascial planes healed without device resurfacing.
- Devices initially relocated to superficial planes required secondary subfascial translocation for healing.
- Bacteriology and antibiotic treatment did not impact the outcome; subfascial location was the key determinant.
Conclusions:
- Subfascial relocation is an effective strategy for managing exposed pacemakers, promoting device healing.
- This approach offers a viable alternative to complete pacemaker unit replacement.
- The depth of the pulse generator's location is critical for successful healing of exposed pacemaker sites.