Plastic & Reconstructive Surgery:
Salvage of Infected Left Ventricular Assist Device with Antibiotic Beads; Management of Deep Brain Stimulator Electrodes Exposure
Guo, Yi M.D.; Bai, Haiya M.D.; Long, Xiao M.D.
Peking Union Medical College Hospital, Beijing, People’s Republic of China
Correspondence to Prof. Long, Peking Union Medical College Hospital, 1 Shuaifuyuan, Wangfujing, Beijing 100032, People’s Republic of China, email@example.com
With great interest, we read the article entitled “Salvage of Infected Left Ventricular Assist Device with Antibiotic Beads.”1 We were deeply impressed by the authors’ successful work in treating 26 patients with left ventricular assist device infections using antibiotic beads. Similarly, our team treated eight patients who suffered deep brain stimulation hardware exposure from 2011 to 2013. In five of these patients, the problems were successfully resolved by débridement and local flap transfer with or without skin graft. Three patients suffered wound dehiscence again and underwent hardware removal.
Deep brain stimulation has been widely applied to patients with movement disorders such as Parkinson disease, essential tremor, dystonia, and others. However, hardware-related complication rates of postoperative incision infection and skin erosion were reported to vary from 7.8 to 26 percent.2–5 It was reported that skin erosion mostly occurred at the connector site. In our case series, five patients suffered frontal area exposure of the burr-hole cap, two suffered postauricular skin erosion, and one suffered chest wall infection. It is difficult to place antibiotic beads in these areas; however, scalp and muscle flaps are believed to have the ability to withstand infection because of their rich blood supply. There are three main arteries adjacent to the area where the deep brain stimulator was inserted: the occipital artery, the temporalis superficial artery, and the thoracoacromial artery (Fig. 1). All of these arteries could be used as the dominant vessel for an island or local flap. Thus, to keep a lifeboat in case the patient suffers hardware exposure, the integrity of these three arteries should be maintained during deep brain stimulator insertion.
An antibiotic-covered catheter was also reported to protect deep brain stimulator leads after infection, with a decreased risk of deep brain stimulator lead damage.5 Compared with the antibiotic-impregnated catheter, local flap transfer is inexpensive and easy to perform. Our preliminary clinical experience in this report indicates its effectiveness (Fig. 2).
The authors have no financial interest to declare in relation to the content of this communication.
Yi Guo, M.D.
Haiya Bai, M.D.
Xiao Long, M.D.
Peking Union Medical College Hospital
Beijing, People’s Republic of China
1. Kretlow JD, Brown RH, Wolfswinkel EM, et al. Salvage of infected left ventricular assist device with antibiotic beads. Plast Reconstr Surg. 2014;133:28e–38e
2. Seijo FJ, Alvarez-Vega MA, Gutierrez JC, Fdez-Glez F, Lozano B. Complications in subthalamic nucleus stimulation surgery for treatment of Parkinson’s disease: Review of 272 procedures. Acta Neurochir (Wien). 2007;149:867–975; discussion 876
3. Sarem-Aslani A, Mullett K. Industrial perspective on deep brain stimulation: History, current state, and future developments. Front Integr Neurosci. 2011;5:46
4. Lyons KE, Wilkinson SB, Overman J, Pahwa R. Surgical and hardware complications of subthalamic stimulation: A series of 160 procedures. Neurology. 2004;63:612–616
5. Voges J, Waerzeggers Y, Maarouf M, et al. Deep-brain stimulation: Long-term analysis of complications caused by hardware and surgery. Experiences from a single centre. J Neurol Neurosurg Psychiatry. 2006;77:868–872
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David H. Song, M.D., M.B.A. is the President-elect of the American Society of Plastic Surgeons (ASPS). He is a consultant with BioMet, Emmi Solutions, LLC, a consortium-member providing senior debt for Brava, and consultant with and investor in HealthEngine.com. He receives author royalties from Elsevier. Scot Glasberg, M.D. is the President of the American Society of Plastic Surgeons (ASPS). He is a consultant with LifeCell Corp and Mentor Corp and an investor with Strathspey Crown. The authors have no sources of funding to report related to the writing or submission of this discussion.
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David H. Song, M.D., M.B.A., 444 E. Algonquin Rd. Arlington Heights, IL 60005, firstname.lastname@example.org
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