THE MANAGEMENT OF SOFT-TISSUE COMPLICATIONS RELATED TO PACEMAKER IMPLANTATIONS

During the last six years (1988-1993) we have treated 15 patients suff ering from soft tissue problems related to pacemaker implantations whi ch included: skin erosions (2 patients), impending extrusion of the pa cemaker pulse generator due to capsular contracture (4 patients), expo sed pacemaker generator (6 patients), and exposed electrode (3 patient s). This article describes a conservative approach to the treatment of these complications. Skin erosions are treated topically with antibac terial creams or solutions. Local infection is controlled by the admin istration of systemic antibiotics according to the antibiogram, as wel l as with local antibacterial dressings. Impending extrusion or exposu re of the pacing system are treated by subcapsular relocation of the p acemaker generator or vertical-to-horizontal transposition of the exte riorized lead. These restricted local surgical interventions are desig ned to overcome the vertical force which tends to cause the extrusion of pacing hardware without using another implantation site which are a lready limited in number. This approach, which can be repeated, preven ts the reintroduction of a new pacing system. The pre-operative evalua tion, surgical techniques and a long term follow-up are presented.