Hansalia Riple, Rose Michael I, Martins Catarina P, Rossi Kristie
Department of Medicine, Division of Cardiology, Jersey Shore University Medical Center, Neptune City, N.J.
Department of Surgery, Division of Plastic Surgery, Jersey Shore University Medical Center, Neptune City, N.J.
Plast Reconstr Surg Glob Open. 2019 May 3;7(5):e2204. doi: 10.1097/GOX.0000000000002204. eCollection 2019 May.
Cardiac implantable electronic device infections are associated with substantial morbidity and mortality. There are varied recommendations in the literature about treatment of the wound after extraction of all hardware, but only conservative, time-consuming approaches such as open packing and negative-pressure therapy along with a long interval before reimplanting any hardware have generally been recommended for the treatment..
A retrospective review was performed of 42 patients treated at Jersey Shore University Medical Center for implantable cardioverter defibrillator and permanent pacemaker infections between July 2010 and April 2018 with an aggressive, multidisciplinary approach utilizing an invasive cardiologist and a plastic surgeon. Clinical and demographic data were collected, and a descriptive analysis was conducted.
A total of 42 patients, with a median age of 76 years, were selected for our treatment of pacemaker pocket infection. Patients underwent removal of all hardware followed by debridement and flap closure of the wound soon after extraction. Reimplantation was performed when indicated typically within a week after initial extraction and typically on the contralateral side. There were no reports of reinfection and no mortality in all 42 patients treated.
We found that the aggressive removal of all hardware and excisional debridement of the entire capsule followed by flap coverage and closure of the wound allowed for a shortened interval to reimplantation with no ipsilateral or contralateral infections during the follow-up period.
心脏植入式电子设备感染与较高的发病率和死亡率相关。文献中对于取出所有硬件后伤口的处理有多种建议，但一般仅推荐采用保守、耗时的方法，如开放换药和负压治疗，且在重新植入任何硬件之前需间隔较长时间。
对2010年7月至2018年4月期间在泽西海岸大学医学中心接受治疗的42例植入式心律转复除颤器和永久性起搏器感染患者进行回顾性研究，采用由侵入性心脏病专家和整形外科医生组成的积极多学科方法。收集临床和人口统计学数据并进行描述性分析。
共选择42例患者接受起搏器囊袋感染治疗，中位年龄为76岁。患者取出所有硬件后，在取出后不久进行清创并皮瓣关闭伤口。通常在初次取出后一周内根据指征进行重新植入，且通常在对侧。在接受治疗的所有42例患者中，均未报告再次感染且无死亡病例。
我们发现，积极取出所有硬件并对整个囊袋进行切除清创，随后皮瓣覆盖并关闭伤口，可缩短重新植入的间隔时间，且在随访期间同侧或对侧均无感染。
