title: Pocket infections of cardiac implantable electronic devices treated by negative pressure wound therapy.
abstract: OBJECTIVE
  Managing an infection of the pocket of a cardiac implantable electronic device (CIED) is frequently challenging. The wound is often treated with a drain or wet-to-dry dressings that allow healing by secondary intention. Such treatment can prolong the hospital stay and can frequently result in a disfiguring scar. Negative pressure wound therapy (NPWT) has been frequently used to promote the healing of chronic or infected surgical wounds. Here we describe the first series of 28 patients in which NPWT was successfully used to treat CIED pocket infections.
  
  
  RESULTS
  After removal of the CIED and debridement of the pocket, a negative pressure of 125 mmHg continuously applied to the wound through an occlusive dressing. Negative pressure wound therapy was continued for a median of 5 days (range 2-15 days) and drained an average of 260 mL sero-sanguineous fluid (range 35-970 mL). At the conclusion of NPWT, delayed primary closure of the pocket was performed with 1-0 prolene mattress sutures. The median length of stay after CIED extraction was 11.0 days (range 2-43 days). Virtually all infected pockets healed without complications and without evidence of recurrent infection over a median follow-up of 49 days (range 10-752 days). One patient developed a recurrent infection when NPWT was discontinued prematurely and a new device was implanted at the infected site.
  
  
  CONCLUSIONS
  We conclude that NPWT is a safe and effective means to promote healing of infected pockets with a low incidence of recurrent infection and a satisfactory cosmetic result.
authors.affiliation: Division of Cardiology, Cardiac Electrophysiology Program, University of California San Diego Health System, Sulpizio Family Cardiovascular Center, La Jolla, CA, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: McGarry
authors.forename: Rajeev
authors.initials: R
authors.lastname: Joshi
authors.forename: Hiro
authors.initials: H
authors.lastname: Kawata
authors.forename: Jigar
authors.initials: J
authors.lastname: Patel
authors.forename: Gregory
authors.initials: G
authors.lastname: Feld
authors.forename: Ulrika M
authors.initials: UM
authors.lastname: Birgersdotter-Green
authors.forename: Victor
authors.initials: V
authors.lastname: Pretorius
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation / Q000379:methods*; D009779:Occlusive Dressings; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000628:therapy*; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
keywords: Cardiac implantable electronic device; Negative pressure wound therapy; Pocket infection