On (b)(6) 2014 it was confirmed that the patient underwent surgery on (b)(6) 2013 to remove the two lead tie-downs.Per the op-notes received, the pre-op diagnosis was that the two tie-down tabs were protruding into the skin with thinning of the skin over the tie-down tabs and concern for skin erosion.It was noted that the patient was hit in the neck by a ball recently and when this happened, these tie-down tabs became more prominent.The surgeon stated that the patient has very thin skin and the tie-down tabs were protruding through the neck and can be seen under the skin to the point where you can almost see the fact that they were white.There was no evidence of skin breakdown or infection during surgery.Diagnostics were performed before and after the removal of the tie-downs confirming lead impedance within normal limits.During removal of one of the tie-downs, scar tissue was removed as well from around the tie-down.
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