# Reinforcement of a Subcutaneous Pocket for Implantable Cardioverter Defibrillator Insertion Using Acellular Dermal Matrix: A Case Report

## TL;DR

A child's ICD implant site was reinforced with a special matrix to prevent complications from a thin chest wall.

## Contribution

Using acellular dermal matrix to reinforce ICD pockets in pediatric patients with thin subcutaneous layers.

## Key findings

- ADM reinforcement prevented ICD protrusion and pocket rupture in a high-risk pediatric case.
- One-year follow-up showed successful engraftment of the ADM with no complications.
- Thin subcutaneous layers increase ICD implantation risks, but ADM can mitigate these risks.

## Abstract

Pediatric patients who undergo implant insertion into the chest wall face a high risk of implant exposure to the external environment. Five months after an 8-year-old boy underwent implantable cardioverter–defibrillator (ICD) implantation in a subcutaneous pocket in the left anterolateral chest wall to manage long QT syndrome, ICD replacement became necessary owing to exposure risk from distal and lateral thinning of the ICD pocket. Pocket rupture and exposure would increase the risk of infection; therefore, we performed ICD removal and primary pocket closure. Two weeks later, a new suprafascial pocket was created, an acellular dermal matrix (ADM) was attached to the inner wall to prevent ICD protrusion, and a new ICD was inserted. One year postoperatively, the ADM was engrafted, and no complications were observed. A thin subcutaneous layer increases the risk of ICD implantation complications. Inner wall strengthening with an ADM can help prevent pocket rupture.