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Related Experiment Video

Updated: May 21, 2025

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Pocket Perforation Using 3-0 Nylon Suture for Device Fixation.

Daisuke Yamazaki1, Mitsunori Yuzurihara1

  • 1Cardiology, Akita Cerebrospinal and Cardiovascular Center, Akita, JPN.

Cureus
|March 21, 2025
PubMed
Summary
This summary is machine-generated.

Pacemaker generator fixation with nylon sutures can lead to skin perforation in elderly patients due to decreased BMI. Using silk sutures or leadless pacemakers can prevent this invasive complication.

Keywords:
nylon suturepacemaker pocket infectionpacemaker’s implantationpocket perforationthin patients

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Area of Science:

  • Cardiology
  • Biomaterials Science

Background:

  • Device infection is a significant complication of pacemaker implantation, occurring in 1.5% of cases.
  • Elderly patients (over 65) are at higher risk for pacemaker-related complications.
  • Standard practice for pacemaker infection involves removal of both generator and pacing lead, a highly invasive procedure.

Observation:

  • A case report details an 83-year-old man experiencing generator fixation suture perforation four years post-pacemaker implantation.
  • The patient's Body Mass Index (BMI) decreased from 20.4 kg/m² to 18.4 kg/m² over four years.
  • A 3-0 nylon suture used for generator fixation perforated the skin due to its sharp tip and the patient's reduced subcutaneous tissue.

Findings:

  • No infection was present, allowing for generator replacement without lead removal.
  • The sharp tip of the nylon suture, exacerbated by tissue thinning, caused the perforation.
  • This case highlights the potential for nylon sutures to penetrate the skin in patients with decreasing BMI.

Implications:

  • Preventive measures include using sutures with lower penetration force, such as silk sutures, for generator fixation.
  • Fixing the generator with the knot positioned posteriorly can minimize risk.
  • The increasing number of elderly patients receiving pacemakers necessitates careful consideration of fixation methods and the potential for leadless pacemaker implantation.