Stapling for wound dehiscence after cardiac implantable electronic device implantation

Fuad Habash, Ozan Paydak, Naga Venkata Pothineni, Peyton Card, Asif A. Sewani

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: Wound dehiscence (WD) has been reported as a complication in 0.3% of cardiac implantable electronic device (CIED) procedures. Stapling has not previously been reported as a treatment modality for WD. Presently described is the experience of a single center with WD and its management. Methods: A retrospective chart review of all patients who underwent CIED implantation between 2009 and 2016, a total of 759 devices, was performed. Results: There were a total of 11 (1.4%) patients with WD. The majority 9/11 patients were female, 5 of 11 (45.5%) had diabetes, and 2 of the 11 patients were immunocompromised due to recent chemotherapy. WD occurred in 6 patients after generator change, in 2 patients after a biventricular device upgrade, in 1 patient after biventricular implantable cardioverter defibrillator (ICD) implantation, in 1 patient after dual-chamber pacemaker implantation, and in 1 patient after subcutaneous ICD implantation. The median time of WD was 6 weeks post procedure (range: 1–20 weeks). In all of the patients, wound stapling was performed under sterile conditions after administering intravenous narcotic analgesics. Eight patients received intravenous antibiotics and all patients received at least 2 weeks of oral antibiotics. Blood cultures were negative in 8/11 (72.7%) patients. However, the wound cultures in 5 patients were positive. The staples were removed in a median of 16 days (range: 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 to manage WD after device implantation. This can be performed as an outpatient procedure and can help avoid unnecessary device extraction.

Original languageEnglish (US)
Pages (from-to)242-247
Number of pages6
JournalTurk Kardiyoloji Dernegi Arsivi
Volume46
Issue number4
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

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Equipment and Supplies
Wounds and Injuries
Implantable Defibrillators
Anti-Bacterial Agents
Narcotics
Immunocompromised Host
Type 2 Diabetes Mellitus
Outpatients
Drug Therapy
Therapeutics

Keywords

  • Device implantation
  • Device infection
  • Wound dehiscence
  • Wound stapling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Stapling for wound dehiscence after cardiac implantable electronic device implantation. / Habash, Fuad; Paydak, Ozan; Pothineni, Naga Venkata; Card, Peyton; Sewani, Asif A.

In: Turk Kardiyoloji Dernegi Arsivi, Vol. 46, No. 4, 01.06.2018, p. 242-247.

Research output: Contribution to journalArticle

Habash, Fuad ; Paydak, Ozan ; Pothineni, Naga Venkata ; Card, Peyton ; Sewani, Asif A. / Stapling for wound dehiscence after cardiac implantable electronic device implantation. In: Turk Kardiyoloji Dernegi Arsivi. 2018 ; Vol. 46, No. 4. pp. 242-247.
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abstract = "Objective: Wound dehiscence (WD) has been reported as a complication in 0.3{\%} of cardiac implantable electronic device (CIED) procedures. Stapling has not previously been reported as a treatment modality for WD. Presently described is the experience of a single center with WD and its management. Methods: A retrospective chart review of all patients who underwent CIED implantation between 2009 and 2016, a total of 759 devices, was performed. Results: There were a total of 11 (1.4{\%}) patients with WD. The majority 9/11 patients were female, 5 of 11 (45.5{\%}) had diabetes, and 2 of the 11 patients were immunocompromised due to recent chemotherapy. WD occurred in 6 patients after generator change, in 2 patients after a biventricular device upgrade, in 1 patient after biventricular implantable cardioverter defibrillator (ICD) implantation, in 1 patient after dual-chamber pacemaker implantation, and in 1 patient after subcutaneous ICD implantation. The median time of WD was 6 weeks post procedure (range: 1–20 weeks). In all of the patients, wound stapling was performed under sterile conditions after administering intravenous narcotic analgesics. Eight patients received intravenous antibiotics and all patients received at least 2 weeks of oral antibiotics. Blood cultures were negative in 8/11 (72.7{\%}) patients. However, the wound cultures in 5 patients were positive. The staples were removed in a median of 16 days (range: 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 to manage WD after device implantation. This can be performed as an outpatient procedure and can help avoid unnecessary device extraction.",
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