The management of soft tissue complications related to pacemaker implantations

During the last six years (1988-1993) we have treated 15 patients suffering from soft tissue problems related to pacemaker implantations which included: skin erosions (2 patients), impending extrusion of the pacemaker pulse generator due to capsular contracture (4 patients), exposed pacemaker generator (6 patients), and exposed electrode (3 patients). This article describes a conservative approach to the treatment of these complications. Skin erosions are treated topically with antibacterial creams or solutions. Local infection is controlled by the administration of systemic antibiotics according to the antibiogram, as well as with local antibacterial dressings. Impending extrusion or exposure of the pacing system are treated by subcapsular relocation of the pacemaker generator or vertical-to-horizontal transposition of the exteriorized lead. These restricted local surgical interventions are designed to overcome the vertical force which tends to cause the extrusion of pacing hardware without using another implantation site which are already limited in number. This approach, which can be repeated, prevents the reintroduction of a new pacing system. The pre-operative evaluation, surgical techniques and a long term follow-up are presented.