Management of exposure of cardiac pacemaker systems

The erosion and exposure of pacemakers are relatively uncommon occurrences but, given the number of these devices inserted yearly, they are nevertheless occurrences that plastic surgeons are likely to encounter in practice. Although there is a general agreement that clinically infected devices are best removed, it has been established that exposed but noninfected devices can usually be managed conservatively with coverage procedures. Reports in the literature, to date, describe a number of different procedures for coverage, and these reports generally comprise small numbers of patients. This study describes 16 patients referred to a single surgeon over a 14-year period with exposure or suspected impending exposure of their cardiac pacemaker systems. Fourteen patients required surgical revision for coverage of either the generator or defunctionalized wires. Equivalent success was achieved with either subfascial or submuscular coverage in 11 patients with generators present. Three patients with exposure of defunctionalized wires achieved successful coverage with submuscular burial. There was no correlation of culture results with recurrence of exposure.