Management of device-related wound complications in deep brain stimulation surgery

OBJECT: Wound complications are uncommon following deep brain stimulation (DBS) surgery. However, certain key technical steps can be performed in each procedure to minimize this still troublesome risk. The authors reviewed the incidence and management of all hardware-related wound dehiscences and infections in a large patient series. METHODS: All patients undergoing new DBS hardware implantation surgery between 2002 and 2010 by a single surgeon (R.K.S.) were entered into a database after undergoing verification by cross-referencing manufacturer implantation records. All hardware-related complications such as wound dehiscence, erosions, and/or infections were identified, and wound location, time of incidence, and mechanism were categorized. Charts were reviewed to evaluate the success of conservative treatment versus partial or total hardware removal. RESULTS: Seven hundred twenty-eight patients received 1333 new DBS leads and 1218 new implantable pulse generators (IPGs) in a total of 1356 stereotactic procedures for movement disorders. Seventy-eight percent of patients underwent staged lead and IPG implantations. Sixteen patients presented with atraumatic device-related infection and/or dehiscence within 12 months from original implantation; 9 of these patients (1.24%) required additional surgery after antibiotic failure. All 8 patients presenting with cranial wound complications were treated initially by debridement in an attempt to salvage the leads; debridement followed by intravenous antibiotics was only successful in 2 patients presenting with dehiscence alone. One of 2 lead-only removals was successful in infections originating in the cranium; the only IPG-originating infection was treated by partial hardware removal and intravenous antibiotics. Two of 637 IPG replacements resulted in infections within 12 months after revision, requiring either partial or total hardware removal, while 1 dehiscence in this group was treated by debridement alone. CONCLUSIONS: In a large series of new DBS hardware implantations, the incidence of postoperative wound dehiscence and/or infections requiring further surgery was 1.24%. Standard practice for all implantations was a short procedural duration, copious povidone-iodine irrigation, and postoperative antibiotic administration. Partial hardware removal should be initially attempted for infection. Debridement alone is successful in treating dehiscence without infection.