J Wound Manag Res.  2024 Oct;20(3):241-250. 10.22467/jwmr.2024.03062.

Risk Factor Analysis and Algorithmic Approach for Managing Deep Brain Stimulation Device-Related Wound Complications

• Yoo H
• Seo J
• Paek SH
• Chang H

• KMID: 2560424
• DOI: http://doi.org/10.22467/jwmr.2024.03062

Abstract

Background
Although implanting deep brain stimulation (DBS) devices carries up to a 15% risk of complications, optimal management strategies remain poorly understood. This study aimed to review the risk factors for wound complications of DBS device implantation and develop an algorithm for proper management.
Methods
Patients with Parkinson disease who underwent bilateral subthalamic nucleus DBS device implantation between 2005 and 2022 were retrospectively reviewed. All DBS-related wound complications such as infection, dehiscence, erosion, and displacement were recorded, and factors associated with device explantation were also assessed.
Results
A total of 398 patients underwent DBS device implantation using 796 electrodes and implantable pulse generators. During the mean follow-up of 9.8 ± 5.5 years, 28 patients (7.0%) experienced wound complications that required reoperation, including 14 infection (50.0%), 22 dehiscence (78.6%), five skin erosion (17.9%), and two device displacement (7.1%). Complications were resolved with a single reoperation in 13 patients (46.4%), while nine patients underwent 2–3 surgical procedures (32.2%), and six patients in 6–8 operations (21.4%). The device was salvaged in 16 patients (57.1%) and removed in 12 (42.9%). Infection (P = 0.010), shorter time interval from device implantation to complications (P = 0.022), higher C-reactive protein levels (P = 0.026), methicillin-resistant Staphylococcus aureus growth (P = 0.044), and history of multiple previous revisions (P < 0.001) were associated with device removal.
Conclusion
To maximize the therapeutic benefit of DBS and minimize the time, effort, and cost required for revision, temporary explantation in early stages followed by reimplantation of the device after the wound subsides should be considered in high-risk cases.

Keyword

Deep brain stimulation; Surgical wound infection; Parkinson disease