Totally implantable subpectoral vs. subcutaneous port systems in children with malignant diseases.
BACKGROUND
For many years, subcutaneous therapeutic port system was known as a major route to access central veins. However, significant complications have been reported through recent years. One of the most important complications of subcutaneous port implantation is skin necrosis. In order to decrease this complication, we would like to introduce subpectoral fascia port implantation through this study.


METHODS
Five hundred and twenty four patients with a variety of neoplastic diseases underwent port implantation, from March 2003 to March 2008 (60 months). All suitable size catheters were put in the superior vena cava through the internal jugular vein under general anesthesia. The ports were placed in the subcutaneous pocket (SCP group) in 342 patients and in the subpectoral fascia pocket (SPFP group) in 182 patients. Data were analyzed using Chi-square test and survival analysis for time (Kaplan-Meier).


RESULTS
A total of 538 devices were placed for 524 patients in two groups (14 patients received a second device after removal of the first one, due to failure of the first implantation). Mean follow-up period was 508 days (8 - 2025 days).Common complications observed in the SPFP group were as follows: wound infection (7 cases, 3.8%), catheter obstruction (7 cases, 3.8%), catheter displacement (6 cases, 3.2%), port related infection (5 cases, 2.7%), and pocket hematoma (2 cases, 1.1%).Common complications observed in the SCP group were as follows: catheter displacement (12 cases, 3.5%), skin necrosis (11 cases, 3.21%), port exposure (9 cases, 2.6%), port related infection (8 cases, 2.3%), catheter obstruction (8 cases, 2.3%), and port rotation (3 cases, 0.9%).


CONCLUSIONS
The results showed that port implantation in the subpectoral fascia pocket had a lower rate of skin complications than the subcutaneous pocket implantation. According to this study, this procedure was not complicated by skin necrosis over the port, port exposure or port rotation.
Rouzrokh
Mohsen
M
Department of Pediatric Surgery, Mofid Children's Hospital, Shaheed Beheshti Medical Sciences University, Tehran, Iran. Mohsen_Rouzrokh@Yahoo.com
Shamsian
Bibi Shahin
BS
KhaleghNejad Tabari
Ahmad
A
Mahmoodi
Morteza
M
Kouranlo
Jafar
J
Manafzadeh
Gholamreza
G
Arzanian
Mohammad Taghi
MT
Fallah
Fateme
F
Anoush
Mahdieh
M
Abdollah Gorji
Fatemeh
F
D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009336:Necrosis; D009369:Neoplasms / Q000188:drug therapy*; D012867:Skin / Q000473:pathology