Methylene Blue-Guided Debridement in Preparation for Cardiac Device Reimplantation: A Retrospective Cohort Pilot Study.

Abstract

Introduction: Debridement of infected wounds is an essential component of wound healing. Surgical debridement is one option and is typically performed under direct visualization of the wound. It is carried out until healthy tissue is felt to be encountered by the surgeon. Methylene blue has been described as a visual aid in the debridement process, including in the setting of infected prostheses. This study aimed to compare wound healing and device reimplantation times between patients who underwent methylene blue-guided debridement or routine wound care of their infected cardiac device implant pockets. Evaluating differences in rates of recurrent infection following reimplantation was a secondary goal of the study.

Methods: Patients were identified for inclusion using a CPT code-based data pull and manual chart review. They were separated into groups dependent upon whether they received routine wound care or methylene blue-guided debridement. Chart review was conducted to estimate the number of days from explantation to wound healing and device reimplantation, and any documentation of reinfection was also recorded. Mann-Whitney U, Student's t, and Chi-square tests were performed using jamovi.

Results: To date, 13 patients have been included in the analysis. Methylene blue-guided debridement is associated with significantly faster time to wound healing (p = 0.011). A significant difference in the interval between explantation and reimplantation was noted, with those in the methylene blue group having shorter intervals (p = 0.036). Differences in reinfection rates were nonsignificant.

Conclusion: Methylene blue-guided debridement appears to significantly improve time to wound healing and time to device reimplantation in patients who have undergone device explantation secondary to infection.