Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, IndiaFulltext PDF
Background:Patients with permanent pacemakers posted for surgical resection of carcinoma alveolus with reconstructive surgery pose several challenges, due to the proximity of the surgical field to the pacemaker. The challenges become nightmares when the flap harvested for reconstruction lies just below the pacemaker. This is probably the second case report in which the reconstructive surgeon had successfully harvested a PMMC flap from the same side as the pacemaker without causing any structural and functional damage to the pacemaker.
Case: We report successful anaesthetic management of an 80-year-old patient of carcinoma alveolus posted for marginal mandibulectomy with flap reconstruction under general anaesthesia, in whom PMMC flap was harvested from the same side of the chest as was his permanent pacemaker. Extreme caution must be executed while separating the subcutaneous tissue containing the pacemaker along with the clavipectoral fascia from the pectoralis muscle and the integrity of the pacemaker leads must be evaluated after the PMMC flap has been delivered into the subcutaneous tunnel above the clavicle.
Conclusion: Interference with pacemaker function due to electrolyte, acid-base disturbances, and electromagnetic interference leading to pacemaker failure and hemodynamic compromise and damage of the pacemaker generator and the leads during the flap harvesting were our primary concerns.
Case report, Pacemaker, Reconstructive surgery
Soumi Pathak.Pectoralis Majore Myocutaneous Flap (PMMC) in A Patient with Ipsilateral Pacemaker Insitu -A Case Report.Int Clinc Med Case Rep Jour. 2022;1(10):1-4.