Turk Kardiyol Dern Ars. 2018; 46(4): 242-247 | DOI: 10.5543/tkda.2018.57059
Stapling for wound dehiscence after cardiac implantable electronic device implantation
, Ozan Paydak, Naga Venkata Pothineni, Peyton Card, Asif Sewani
Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
OBJECTIVE Wound dehiscence (WD) has been reported as a complication in 0.3% of cardiac implantable electronic device (CIED) procedures. Stapling has not previously been reported as a treatment modality for WD. Presently described is the experience of a single center with WD and its management.
METHODS A retrospective chart review of all patients who underwent CIED implantation between 2009 and 2016, a total of 759 devices, was performed.
RESULTS There were a total of 11 (1.4%) patients with WD. The majority 9/11 patients were female, 5 of 11 (45.5%) had diabetes, and 2 of the 11 patients were immunocompromised due to recent chemotherapy. WD occurred in 6 patients after generator change, in 2 patients after a biventricular device upgrade, in 1 patient after biventricular implantable cardioverter defibrillator (ICD) implantation, in 1 patient after dual-chamber pacemaker implantation, and in 1 patient after subcutaneous ICD implantation. The median time of WD was 6 weeks post procedure (range: 120 weeks). In all of the patients, wound stapling was performed under sterile conditions after administering intravenous narcotic analgesics. Eight patients received intravenous antibiotics and all patients received at least 2 weeks of oral antibiotics. Blood cultures were negative in 8/11 (72.7%) patients. However, the wound cultures in 5 patients were positive. The staples were removed in a median of 16 days (range: 936 days). All of these patients were successfully treated with stapling and none of the devices required extraction.
CONCLUSION Stapling under sterile conditions may be an acceptable treatment strategy to manage WD after device implantation. This can be performed as an outpatient procedure and can help avoid unnecessary device extraction.
Device implantation, device infection; wound dehiscence; wound stapling.
How to cite this article
Fuad Habash, Ozan Paydak, Naga Venkata Pothineni, Peyton Card, Asif Sewani. Stapling for wound dehiscence after cardiac implantable electronic device implantation. Turk Kardiyol Dern Ars. 2018; 46(4): 242-247
Corresponding Author: Fuad Habash, United States