Ortler M, Luef G, Kofler A, Bauer G, Twerdy K
Universitätskliniken für Neurochirurgie and Neurologie, 35, Innsbruck 6020, Austria.
Epilepsia. 2001 Jan;42(1):133-5. doi: 10.1046/j.1528-1157.2001.23800.x.
Effective treatment of deep wound infection without removal of a previously implanted foreign body is difficult. The Neurocybernetic Prosthesis (NCP) System (Cyberonics Inc., Webster, TX, U.S.A.), implanted for vagus nerve stimulation in patients with medically refractory epilepsy, uses coil-like electrodes placed around the left vagus nerve after exposure of the nerve in the carotid sheath. Infection within this compartment endangers the contained structures and makes removal of the system hazardous. We report the case of one patient implanted with the NCP who underwent successful open wound treatment without removal of the system. A 35-year-old man had local signs of wound infection 5 weeks after implantation of a vagus nerve stimulator. Systemic signs of infection were absent. C-reactive protein was slightly elevated, but all other laboratory values were normal. After open wound debridement and thorough rinsing with bacitracin-containing solution, the wound was packed with 3% iodoformized gauze. The NCP was left in place. Systemic antibiotic therapy with fosfomycin and cefmenoxim was started. Cultures confirmed an infection with Staphylococcus aureus. The wound was rinsed daily with 3% hydrogen peroxide solution and 5% saline until cultures were sterile and granulation tissue started to fill the wound. Delayed primary closure was performed 2 weeks later. Wound healing was accomplished without removal of the device. No signs of recurrent infection were observed during a follow-up of 1 year. Open wound treatment without removal of the implanted vagus nerve stimulator is feasible in cases of deep cervical wound infection and can be an alternative if removal of the device appears hazardous.
在不移除先前植入的异物的情况下有效治疗深部伤口感染是困难的。神经控制假体（NCP）系统（美国德克萨斯州韦伯斯特市的Cyberonics公司），植入用于治疗药物难治性癫痫患者的迷走神经刺激，在颈动脉鞘内暴露神经后，使用盘绕状电极环绕左迷走神经。该区域内的感染会危及其中的结构，并使系统的移除变得危险。我们报告了一例植入NCP的患者，该患者在不移除系统的情况下成功接受了开放性伤口治疗。一名35岁男性在植入迷走神经刺激器5周后出现伤口感染的局部体征。无全身感染体征。C反应蛋白略有升高，但所有其他实验室值均正常。在开放性伤口清创并用含杆菌肽的溶液彻底冲洗后，伤口用3%碘仿纱布填塞。NCP留在原位。开始使用磷霉素和头孢甲肟进行全身抗生素治疗。培养证实感染了金黄色葡萄球菌。每天用3%过氧化氢溶液和5%盐水冲洗伤口，直到培养无菌且肉芽组织开始填充伤口。两周后进行延迟一期缝合。伤口愈合完成，未移除装置。在1年的随访期间未观察到复发感染的迹象。对于深部颈部伤口感染，不移除植入的迷走神经刺激器进行开放性伤口治疗是可行的，如果移除装置似乎有危险，这可以是一种替代方法。
