Plastic & Reconstructive Surgery:
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, firstname.lastname@example.org
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
Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.
Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.
Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/.
We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.
The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.