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Reply: Salvage of Infected Left Ventricular Assist Device with Antibiotic Beads; Management of Deep Brain Stimulator Electrodes Exposure

Wolfswinkel, Erik B.S.; Izaddoost, Shayan M.D., Ph.D.

Plastic and Reconstructive Surgery: September 2014 - Volume 134 - Issue 3 - p 488e–489e
doi: 10.1097/PRS.0000000000000437
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Division of Plastic Surgery, Baylor College of Medicine

Jamail Specialty Care Center, Baylor College of Medicine, Houston, Texas

Correspondence to Dr. Izaddoost, Jamail Specialty Care Center, Baylor College of Medicine, 1977 Butler Boulevard, Suite E6.100, Houston, Texas 77030, shayani@bcm.edu

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Sir:

We appreciate Dr. Long’s interest in our article, “Salvage of Infected Left Ventricular Assist Device with Antibiotic Beads,”1 and applaud his efforts to provide a solution to a very difficult problem of deep brain stimulator electrode exposure. Exposed hardware of any type presents an arduous task to manage. A balance of expediency and caution is required when mitigating the risks of infection, reoperation, and need for hardware removal.

Several studies have been performed analyzing hardware-related complications of deep brain stimulators.2 Infections and/or skin erosions on average are reported in 7.4 percent of patients.2 There appears to be no consensus about the best treatment of such cases, in part because of the economic costs and possible complications related to implant removal and replacement. Lanotte et al. recently published a case report describing successful management of skin erosion following deep brain stimulator hardware exposure using scalp flap reconstruction over the area of system exposure similar to that performed by Dr. Long.3 In our experience, débridement, antibiotic washout, and repeated coverage with local tissue transfer has been effective in preventing the need for hardware removal in similar cases, where no clinical infection had been detected. In situations with frank purulence at the site of exposure, antibiotic beads can be an option for salvage.

With growing acceptance of the deep brain stimulator and the increasing number of implantations, complications are likely to be seen more frequently. Thus, communications on complication management and avoidance are fundamental. This report by Dr. Long on the management of skin erosions should stimulate further experts in the field of plastic surgery and neurosurgery to share their experiences in complication management.

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DISCLOSURE

The authors have no financial interest to declare in relation to the content of this communication.

Erik Wolfswinkel, B.S.

Division of Plastic Surgery

Baylor College of Medicine

Shayan Izaddoost, M.D., Ph.D.

Jamail Specialty Care Center

Baylor College of Medicine

Houston, Texas

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REFERENCES

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. Hamani C, Lozano AM. Hardware-related complications of deep brain stimulation: A review of the published literature. Stereotact Funct Neurosurg. 2006;84:248–251
3. Lanotte M, Verna G, Panciani PP, et al. Management of skin erosion following deep brain stimulation. Neurosurg Rev. 2009;32:111–115
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