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Mechanical Effects of Cardiovascular Drugs and Devices
Published in Michel R. Labrosse, Cardiovascular Mechanics, 2018
This section addresses devices with long-term exposure to blood and cardiovascular tissue. These are divided into vascular implants and cardiac implants. Long-term complications resulting from implanted devices include those mentioned previously from vessel wall damage and thrombosis, as well as complications from surgical attachment. Dehiscence is the failure of the wounds inflicted during surgery to heal, usually at the sutured connection of the device to the native tissue. During surgery, the sutures can be tied too tightly, causing necrosis or ischemia, especially when postoperative edema expands the tissue volume. Conversely, sutures that are tied too loosely can become untied, allowing the wound to open before it is healed. This can result in a separation of the implant from the native tissue at the attachment site. When this occurs in vascular implants, there can be leakage into the tissue, outside of the vascular space. When dehiscence occurs in the heart, as with heart valves or annuloplasty rings, it results in a paravalvular orifice that allows for regurgitation, ultimately causing implant failure and a need for reoperation. Dehiscence is often accompanied by infection, either from the initial implant surgery or developing later from some other source of endocarditis.21
Vestibular and Related Oculomotor Disorders
Published in Anthony N. Nicholson, The Neurosciences and the Practice of Aviation Medicine, 2017
Nicholas J. Cutfield, Adolfo M. Bronstein
A perilymphatic fistula is a serious condition for aircrew due to the symptoms induced and the possibility of pressure changes during flight. In a series of four cabin attendants with perilymphatic fistula, none of whom was diagnosed at the primary care level, only one was able to return to flying duties (Klokker and Vesterhauge, 2005). Prior to the event, three of the four had a common cold that reduced the ability to equalize pressure in the ears during pressure changes in flight. Initial treatment is bed rest and avoidance of physical effort that may give pressure surges. Surgical repair is possible depending on the anatomy of the dehiscence.
Anticipating and preventing complications in spinal cord stimulator implantation
Published in Expert Review of Medical Devices, 2023
Steven M. Falowski, Hao Tan, Joseph Parks, Alaa Abd-Elsayed, Ahmed Raslan, Jason Pope
Our Authors wanted to highlight the potential for allergic reaction to the implant components, albeit exceedingly rare based on post-marketing surveillance data [2]. It is best practice to keep potential allergic reaction or inflammatory response to device components, dressings, and/or suture material on one’s differential for post-operative patients presenting with localized cutaneous irritation with associated pruritis and erythema. This may lead to potential surgical wound delayed healing, dehiscence, and infection. Although there is no NACC recommendation to support implementing patch testing as a standardized protocol in the preoperative setting, appropriate clinical discretion on a case-by-case base would be appropriate.