Dermatologic surgery on the chest wall in patients with a cardiac surgery history: a review of material that may be encountered intraoperatively, including potential complications and suggestions for proceeding safely

Abstract

Background: Thoracic surgical procedures and the use of cardiac devices such as pacemakers are becoming increasingly prevalent in the population. As such, dermatologists may have a greater likelihood of encountering previously implanted or abandoned surgical material in the course of dermatologic surgery on the chest wall. A basic understanding of the wire types and the tunneling paths utilized in such procedures is important in accurately anticipating the presence of these wires to effectively manage any chance encounters. Objective: We present a review on temporary epicardial pacing wires, temporary transvenous pacing wires, pacemaker leads, and surgical steel sutures in the context of dermatologic surgery. Methods: A literature review was performed on frequently used wire material in patients with a history of cardiac surgery as well as related dermatologic complications from these materials. Results & Conclusion: Dermatologic surgeons should particularly be aware that temporary epicardial pacing wires and pacemaker leads are not uncommonly abandoned in the chest wall of many patients. All patients with a cardiac surgery history should be questioned about possible retained wires. If wire material is encountered intraoperatively, immediately stop the procedure and do not attempt further manipulation of the wire until suggested steps are taken to ascertain the wire type. Keywords: dermatologic surgery, electrosurgery, pacemaker, pacer wire, steel suture