title: Efficacy and feasibility of the submuscular implantation technique for an implantable cardiac electrical device.
abstract: BACKGROUND
  A common complication associated with implantable cardiac electrical device implantation compromises skin lesions caused by overstretching just above a buried device that is relatively large in size. Apart from affecting the cosmetic appearance in some patients, a compromised blood supply to the skin may also lead to ischemic necrosis, which is an important complication. We describe a novel procedure for the implantation of implantable cardiac electrical devices generators under the pectoralis major muscle to avoid such skin-related complications.
  
  
  METHODS
  Twenty-one patients were referred to plastic surgeon for surgical support for the secondary replacement of implantable cardiac electrical devices. In all cases, the leads and devices had been implanted under the skin. We decided to perform device implantation under the pectoralis major muscle, which was highly recommended in all these patients.
  
  
  RESULTS
  In Japan, leanness is determined on the basis of body mass index less than 18.5, and 11 patients out of 21 (52%) were considered to be lean. The surgeon's participation in the procedure for implantable cardiac electrical device implantation did not exceed 5 minutes in total.
  
  
  CONCLUSIONS
  We consider that the novel method of sub-pectoralis major muscle device implantation described here minimizes the risk of the skin breakdown and improves the patient's quality of life.
authors.affiliation: Departments of Plastic and Reconstructive Surgery, Kinki University Faculty of Medicine. Osaka-Sayama, Osaka, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Asamura
authors.affiliation: Departments of Cardiology, Kinki University Faculty of Medicine. Osaka-Sayama, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kurita
authors.affiliation: Departments of Cardiology, Kinki University Faculty of Medicine. Osaka-Sayama, Osaka, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Motoki
authors.affiliation: Departments of Cardiology, Kinki University Faculty of Medicine. Osaka-Sayama, Osaka, Japan.
authors.forename: Ryobun
authors.initials: R
authors.lastname: Yasuoka
authors.affiliation: Departments of Plastic and Reconstructive Surgery, Kinki University Faculty of Medicine. Osaka-Sayama, Osaka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hashimoto
authors.affiliation: Departments of Plastic and Reconstructive Surgery, Kinki University Faculty of Medicine. Osaka-Sayama, Osaka, Japan.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Isogai
keywords: Asians; cardiologist; implantable cardiac electrical devices; pectoralis major muscle; skin-related complications