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All Journal Majalah Kedokteran Bandung Althea Medical Journal Majalah Kedokteran Gigi Indonesia JURNAL PENDIDIKAN JASMANI DAN OLAHRAGA Jurnal Plastik Rekonstruksi Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Ilmu Bedah Indonesia Bioscientia Medicina : Journal of Biomedicine and Translational Research Action Research Literate (ARL)
Rani Septrina
Department Of Plastic And Reconstructive Surgery, Faculty Of Medicine, Padjajaran University, Bandung, West Java
Biochemistry, Genetics & Molecular Biology Civil Engineering, Building, Construction & Architecture Dentistry Education Environmental Science Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Mathematics Medicine & Pharmacology Neuroscience Public Health Social Sciences Other

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Dual-Modality Salvage of Recurrent Pacemaker Extrusion in Severe Malnutrition: A Technique Using PTFE Mesh Encapsulation and Fasciocutaneous Flap Coverage Rani Septrina; Fidi Bhawana Jaya; Euis Maryani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1568

Abstract

Background: Permanent pacemaker implantation in pediatric patients with severe malnutrition presents a unique surgical challenge due to the absence of a viable subcutaneous protective envelope. In this population, standard device fixation frequently results in recurrent wound dehiscence and device extrusion, often necessitating lead abandonment or epicardial placement. This study evaluates the efficacy of a dual-modality salvage technique integrating a Polytetrafluoroethylene (PTFE) mesh barrier with vascularized fasciocutaneous tissue coverage. Case presentation: We present the case of a 3-year-old male with congenital complete atrioventricular block and severe acute malnutrition, defined by a Weight-for-Height Z-score of less than -3 SD. The clinical course was complicated by three consecutive implant failures over an 8-month period, including two thoracic and one abdominal extrusion, characterized by aseptic pressure necrosis. To salvage the cardiac hardware, a novel sealed-device technique was employed. The pulse generator was encapsulated in a non-absorbable PTFE mesh to minimize the coefficient of friction and placed in a sub-fascial plane. Simultaneously, a random-pattern fasciocutaneous rotation flap was harvested to provide robust, vascularized coverage. Biochemical analysis revealed severe hypoalbuminemia (2.1 g/dL) and anemia pre-operatively. Conclusion: At the 12-month follow-up, the surgical site demonstrated complete physiological integrity with no recurrence of erosion, seroma, or infection. The combination of PTFE encapsulation to mitigate mechanical shearing forces and a fasciocutaneous flap to restore perfusion offers a durable salvage strategy for refractory device extrusion in cachectic pediatric patients.
Co-Authors Amelia Febrina Anjani, Gebby Reviana Apriliani, Ardhia Rizki Astrid Feinisa Khairani Bashari, Muhammad Hasan Dimas Erlangga Luftimas Dwinanda, Arief Endang Syamsudin Euis Maryani Fidi Bhawana Jaya Gema Putra Lesmana Hardisiswo Soedjana Hermin Aminah Usman Khafifah, Dinda Salsa Kiki Akhmad Rizki, Kiki Akhmad Kiki Lukman Labibah, Salma Nur Laraswita, Sarah Lisa Hasibuan Meinarni, Retno Melita Sylvyana Nadiah, Zahra Nugraha, Marwan Agung Nurhasanah Nurhasanah Puji Yuli Christiani Purba Putie Hapsari Rahman, Putri Halleyana A Ramdhani, Muhammad Farid Rendy Susanto Reno Rudiman Rika Mustika Ryanda, Hanno Selvy Harianti Sudjatmiko, Gentur Sudjatmiko, Gentur Teguh Marfen Djajakusumah Teguh Marfen Djajakusumah, Teguh Marfen Titing Nurhayati