Turk Kardiyol Dern Ars. Ahead of Print: TKDA-57059 | 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
BACKGROUND Wound dehiscence (WD) has been reported as a complication in 0.3% of Cardiac Implantable Electronic Device (CIED) procedures. Stapling has not been reported as a treatment modality for WD.
OBJECTIVE We report our single center experience of WD and its management
METHODS Retrospective chart review of all patients who underwent CIED implantation between 2009 and 2016 with a total of 759 devices.
RESULTS There were a total of 11 patients with WD (1.4%), majority (9/11) were female, 5/11 (45.5%) had diabetes and 2/11 patients were immune-compromised due to recent chemotherapy. WD occurred in 6 patients after generator change, 2 patients after a biventricular device upgrade, 1 patient after biventricular ICD implantation, 1 patient after dual chamber pacemaker implantation and in 1 patient after subcutaneous ICD implantation. Median time to WD was 6 weeks post procedure (1-20 weeks). In all patients, wound stapling was performed under sterile conditions after administering intravenous narcotic analgesics. 8 patients received intravenous antibiotics and all patients received at least two weeks of oral antibiotics. In patients who were admitted (8/11), blood cultures were negative. However, wound cultures in 5 patients were positive. Median time to removing staples was 16 days (9-36 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 for management of device WD. This procedure can be performed as outpatient and can help avoid unnecessary device extraction.
Wound dehiscence, device infection, device implantation, wound stapling
How to cite this article
Corresponding Author: Fuad Habash, United States