Skin Erosion and Exteriorisation of a Cardiac Implantable Electronic Device: Modified Surgical Approach

Skin erosion and exteriorization of the commonest cardiac implantable electronic device (cied) is usually caused by localized infection as a result of “pocket” infection. but, there are other recognized factors including an advanced age with thin, fragile skin with precarious subcutaneous fat. so, exteriorisation of a generator, and/or a lead, is not always associated with bacterial contamination followed by antibiotic therapy and contra-lateral re-implantation strategy. hence, it does not always make the removal of the material an obligation. our notable findings in a rare case of such exteriorization stimulate us to look for and implement a modified surgical technique. this 93-year-old extremely aged wonderfully co-operative, multi-morbid woman had multiple episodes of skin erosion and fixation, re-fixation surgery till the best result achieved. we present a new technique for cardiac pacing allowing for full patient recovery via an alternative surgical way of cied relocation.