title: Deep wound infection after vagus nerve stimulator implantation: treatment without removal of the device.
abstract: Effective treatment of deep wound infection without removal of a previously implanted foreign body is difficult. The Neurocybernetic Prosthesis (NCP) System (Cyberonics Inc., Webster, TX, U.S.A.), implanted for vagus nerve stimulation in patients with medically refractory epilepsy, uses coil-like electrodes placed around the left vagus nerve after exposure of the nerve in the carotid sheath. Infection within this compartment endangers the contained structures and makes removal of the system hazardous. We report the case of one patient implanted with the NCP who underwent successful open wound treatment without removal of the system. A 35-year-old man had local signs of wound infection 5 weeks after implantation of a vagus nerve stimulator. Systemic signs of infection were absent. C-reactive protein was slightly elevated, but all other laboratory values were normal. After open wound debridement and thorough rinsing with bacitracin-containing solution, the wound was packed with 3% iodoformized gauze. The NCP was left in place. Systemic antibiotic therapy with fosfomycin and cefmenoxim was started. Cultures confirmed an infection with Staphylococcus aureus. The wound was rinsed daily with 3% hydrogen peroxide solution and 5% saline until cultures were sterile and granulation tissue started to fill the wound. Delayed primary closure was performed 2 weeks later. Wound healing was accomplished without removal of the device. No signs of recurrent infection were observed during a follow-up of 1 year. Open wound treatment without removal of the implanted vagus nerve stimulator is feasible in cases of deep cervical wound infection and can be an alternative if removal of the device appears hazardous.
authors.affiliation: Universitätskliniken für Neurochirurgie and Neurologie, 35, Innsbruck 6020, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Ortler
authors.forename: G
authors.initials: G
authors.lastname: Luef
authors.forename: A
authors.initials: A
authors.lastname: Kofler
authors.forename: G
authors.initials: G
authors.lastname: Bauer
authors.forename: K
authors.initials: K
authors.lastname: Twerdy
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020878:Device Removal / Q000706:statistics & numerical data; D004599:Electric Stimulation Therapy / Q000009:adverse effects* / Q000295:instrumentation; D004567:Electrodes, Implanted / Q000009:adverse effects / Q000382:microbiology; D004827:Epilepsy / Q000628:therapy*; D004866:Equipment Contamination; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D019736:Prostheses and Implants / Q000009:adverse effects; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D014630:Vagus Nerve / Q000502:physiology*
chemical_list: D000900:Anti-Bacterial Agents