Zeppa Pietro, Fraccalvieri Marco, Fronda Chiara, Lo Bue Enrico, Rizzi Laura, Caliendo Virginia, Lanotte Michele Maria
Stereotactic and Functional Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", AOU Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy.
Plastic Surgery Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy.
Brain Sci. 2022 Dec 15;12(12):1715. doi: 10.3390/brainsci12121715.
Skin erosion is a hardware-related complication commonly described after deep brain stimulation (DBS). Hardware exposure is often associated with the development of infection that can lead to implant removal. However, in selected cases, it is possible to manage skin erosion without having to remove the hardware. This article presents the case of a patient with recurrent skin erosions above the IPG, who underwent multiple surgeries. Given the failure of less invasive approaches, a more complex surgery with the employment of a pedunculated flap of pectoralis major in order to cover the IPG was attempted. Nevertheless, the IPG removal was finally unavoidable, resulting in a rapid decline in clinical performance. This illustrative case suggests how, in patients with sustained stimulation who benefit from a good degree of autonomy, it may be useful to use invasive surgical techniques to resolve skin erosions and save the DBS system. In spite of everything, sometimes complete or partial removal of the implant still becomes unavoidable, but this can lead to a severe worsening of PD symptoms. Definitive removal of the system should therefore be considered only in cases of frank infection or after failure of all other approaches.
皮肤糜烂是深部脑刺激（DBS）术后常见的与硬件相关的并发症。硬件暴露常与感染的发生相关，感染可能导致植入物移除。然而，在某些特定情况下，有可能在不移除硬件的情况下处理皮肤糜烂。本文介绍了一例患者，其植入式脉冲发生器（IPG）上方反复出现皮肤糜烂，接受了多次手术。鉴于侵入性较小的方法失败，尝试了一种更复杂的手术，采用带蒂胸大肌皮瓣覆盖IPG。尽管如此，最终还是不可避免地移除了IPG，导致临床症状迅速恶化。这个典型案例表明，对于那些持续接受刺激且具有较高自主能力的患者，采用侵入性手术技术解决皮肤糜烂并挽救DBS系统可能是有用的。尽管如此，有时完全或部分移除植入物仍然不可避免，但这可能导致帕金森病（PD）症状严重恶化。因此，仅在明确感染或所有其他方法均失败的情况下，才应考虑最终移除该系统。
