Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA.
Pacing Clin Electrophysiol. 2021 May;44(5):765-772. doi: 10.1111/pace.14235. Epub 2021 Apr 19.
Guidance for wound management of the vacated generator pocket in cardiac implantable electronic device (CIED) pocket infections after removal of all hardware and tissue debridement is limited. The typical surgical technique for management of a purulent wound is to allow healing by secondary intention. An alternative approach uses negative pressure wound therapy with or without delayed primary closure. While effective in managing infection, these approaches increase hospital length of stay and costs. We present our experience with a third option: modified early primary wound closure over a suction device.
All patients with CIED pocket infections who presented to our institution between September 2018 and October 2020 underwent extraction of hardware and modified primary wound closure over a negative pressure Jackson-Pratt drain. Length of hospital and postoperative stay, complications, and recurrent infections were recorded.
During the study period, 14 patients underwent modified primary wound closure for CIED pocket infections. Mean length of hospital stay was 6.64 days ± 4.01 days (standard deviation [SD]). Mean postoperative length of stay was 3.92 ± 2.21 days (SD). Two patients (both on intravenous heparin for mechanical valve prostheses) required re-exploration for bleeding. No patients developed recurrent infection at a mean follow up of 363 ± 245 days (SD).
Based on our experience, early modified primary wound closure for CIED pocket infections appears to be safe and allows for prompt discharge with no observed re-infections.
在移除所有硬件和组织清创后，心脏植入式电子设备 (CIED) 口袋感染中 vacated generator 口袋的伤口管理指南有限。处理脓性伤口的典型手术技术是让伤口二期愈合。另一种方法是使用负压伤口治疗，有或没有延迟一期闭合。虽然这些方法在控制感染方面非常有效，但会增加住院时间和费用。我们介绍了我们在第三种选择方面的经验：在抽吸装置上进行改良早期一期伤口闭合。
2018 年 9 月至 2020 年 10 月期间，我们机构收治的所有 CIED 口袋感染患者均接受了硬件取出和改良的一期伤口闭合，在负压 Jackson-Pratt 引流管上进行。记录住院和术后时间、并发症和复发性感染。
在研究期间，有 14 名患者因 CIED 口袋感染接受了改良一期伤口闭合。平均住院时间为 6.64 天±4.01 天（标准差）。平均术后住院时间为 3.92±2.21 天（标准差）。有 2 名患者（均因机械瓣膜假体而接受静脉内肝素治疗）因出血需要再次探查。在平均 363±245 天（标准差）的随访中，没有患者发生复发性感染。
根据我们的经验，CIED 口袋感染的早期改良一期伤口闭合似乎是安全的，并允许在没有观察到再感染的情况下迅速出院。
