Deep wound infection after vagus nerve stimulator implantation: Treatment without removal of the device

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 st imulation in patients with medically refractory epilepsy, uses coil-like el ectrodes placed around the left vagus nerve after exposure of the nerve in the carotid sheath. Infection within this compartment endangers the contain ed 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 el evated, but all other laboratory values were normal. After open wound debri dement 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 con firmed an infection with Sraphylococcus aureus. The wound was rinsed daily with 3% hydrogen peroxide solution and 5% saline until cultures were steril e and granulation tissue started to fill the wound. Delayed primary closure was performed 2 weeks later. Wound healing was accomplished without remova l of thr device. No signs of recurrent infection were observed during a fol low-up of 1 year. Open wound treatment without removal of the implanted vag us nerve stimulator is feasible in cases of deep cervical wound infection a nd can be an alternative if removal of the device appears hazardous.