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Subcutaneous
Intramuscular
2a. Using a mayo scissors bluntly dissect
under the skin to form a pocket
approximately the size of the device body.
2b. Using a gridding technique, bluntly
separate the superficial external abdominal
oblique muscle along the fibers running
craniodorsal to caudoventrally. Be cautious
not to dissect too deeply and enter the
abdominal cavity.
4a. Pass a trochar and cannula can between
the small stab incision for antenna
placement and the larger incision for device
placement.
4b. See 4a.
3a. The device body should be placed in the
pocket created using blunt dissection, and
sutured to the underlying muscle using non-
absorbable suture material through the
suture aids. The antenna should be passed
through the cannula so it lies at a 90 degree
angle to the device body.
3b. The device body should be placed in this
space created between the external and
internal abdominal oblique muscles, with
their fibers running in opposite directions.
The device should be secured to the
underlying muscle using non-absorbable
sutures through the suture aids. The
antenna should be passed through the
cannula so it lies at a 90 degree angle to the
device body.
4. The catheters and biopotential leads now need to be routed to their implantation sites.
The first step to do this requires a skin incision be made over the planned implantation site
(i.e. left jugular furrow for negative solid tip lead, medial thigh for medial saphenous artery
etc.).
5. A cannula and trochar can then be passed between the two incisions, the trochar
removed, the catheter(s) and biopotential leads passed through the cannula and the
cannula removed. If necessary to navigate difficult anatomy, an incision can be made
partway between the origin and the planned implantation site, allowing for easier navigation
of corners, angles etc. The surgeon is likely to pass the cannual and trochar multiple times
to route the catheter(s) and biopotential leads to multiple different implantation locations.
6. AFTER the catheter(s), biopotential leads and antenna have been directed to their
appropriate locations, the incision can be closed in layers.
Subcutaneous
Intramuscular
a. First the muscle can be gently
approximated in a simple continuous suture
pattern using an absorbable suture material
on a tapered point needle. Subcutaneous
tissue can also be approximated similarly.
The skin can be closed using an
intradermal/subcuticular suture pattern with
a cutting needle. The stab incision for
b. Subcutaneous tissue can also be
approximated similarly. The skin can be
closed using an intradermal/subcuticular
suture pattern with a cutting needle. The
stab incision for placement of the antenna
should also be closed using an
intradermal/subcuticular pattern.
