Pedicled Muscle Flap Closure for Chronic Wounds Associated with Ventricular Assist Devices
Joseph S. Khouri, MD, Lauren O. Roussel, BA, Peter F. Koltz, MD, Oren P. Mushin, MD, Derek E. Bell, MD, Howard N. Langstein, MD, Jose Guilherme Christiano, MD.
University of Rochester, Rochester, NY, USA.
End stage cardiac disease has resulted in an increased utilization of cardiac transplantation or long-term mechanical assistance in order to sustain life. Though left ventricular assist devices(LVAD) have revolutionized the treatment algorithm for these patients, these devices carry a substantial infection rate, ranging from 30-50%. We report our institutions experience with attempted flap salvage for infected and exposed LVADs.
A retrospective review for all LVAD pocket related infections treated with flaps at our institution from 2010-2014.
9 flaps were perfomed in 8 patients from 2010-2014. Average age was 59 years. There were 2 females and 7 males with average body mass index of 35.6. Surgery was indicated for LVAD motor or drive line exposure in all cases. The average time to device exposure resulting in consultation was 740 days. Rectus abdominus (n=7) and omentum (n=2) were used for coverage. Skin grafting was utilized in 7 cases with average area 137 cm2. Complications resulted in 67% of cases includinghematoma(2), abscess, seroma(2), cellulitis, and hernia at donor site. There was one flap loss (11%) in a patient that died during hospitalization.
LVADs are life-saving interventions for patients with severe cardiac disease but are associated with a significant rate of complications. While device coverage carries a high rate of complications, no devices required exchange due to infection or failed attempts at salvage.
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