Atrotech Atrostim PNS Anwenderhandbuch Seite 45

Surgical procedure for pediatric patients
Fig. 9.
Using a tunneling tool a subcutaneous tunnel is created from the site where the wire
lead exits the thorax to a implant stimulator pocket. Plug a shield cap over the
electrode connector. Grasp the free end of the shield cap with forceps or pass a suture
through it, Fig. 10. Do not compress the connector portion of the cap. Draw the
electrode wire lead laterally until it exits through the tunnel. Remove the tool and
keep it available for the other side.
Possible variation
An alternative method has been developed for connecting electrodes and implant stimulators
in small and slim children. Using a tunneling instrument, a tunnel is created from the bottom
of the diaphragmatic recessus down to the anterior abdominal wall. Through this tunnel the
connecting wire is pulled and the implant stimulators are placed into the abdominal wall
(Amato 1998, pers.comm., Amato et al. 1978).
CAUTION: Tunneling the wire lead through or adjacent to a moving or contracting
muscle may expose the wire lead to stresses exceeding limits shown in Fig. 9.
D = 9mm (3/8 in)
The maximum pull-out force and the minimum bending curvature
along the wire lead.
14
Atrostim PNS
F = 100N (22lbs)
April 2008