Atiyeh Bishara S, Hayek Shady N, Skaf Ghassan S, Al Araj Ali, Chamoun Roukoz B
Division Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Int Wound J. 2006 Mar;3(1):23-8. doi: 10.1111/j.1742-4801.2006.00179.x.
Programmable pump for continuous infusion of intrathecal baclofen, an agonist of the inhibitory neurotransmitter gamma-aminobutyric acid, is nowadays being widely used to control spasticity. The most common complications leading to explantation of the pumps are skin breakdown and infection at the pump implantation site which cannot be effectively treated without pump removal. We report a 37-year-old man who developed a baclofen pump pocket infection that did not respond to antibiotic therapy. Because the continuation of intrathecal baclofen administration was critical to the patient, and because the high cost of the pump precluded its prompt replacement, the pump was salvaged using the ipsilateral rectus abdominis muscle that was elevated on its inferior vascular pedicle and wrapped around the pump. Abdominal skin was then approximated, leaving a small portion of exposed muscle overlying the refill site that was covered by a split-thickness skin graft. Continuous intrathecal baclofen administration was never discontinued. Three months later, the pump's refill site could be easily identified manually for pump refill. There were no signs of recurrent infection during the 2-year follow-up period.
用于持续鞘内注射巴氯芬（一种抑制性神经递质γ-氨基丁酸的激动剂）的可编程泵如今被广泛用于控制痉挛。导致泵移除的最常见并发症是泵植入部位的皮肤破损和感染，若不移除泵则无法有效治疗。我们报告了一名37岁男性，他发生了巴氯芬泵囊袋感染，对抗生素治疗无反应。由于持续鞘内注射巴氯芬对患者至关重要，且由于泵的高昂成本使其无法迅速更换，于是利用其下方血管蒂掀起的同侧腹直肌包裹泵，挽救了该泵。然后将腹部皮肤拉拢，在补液部位上方留下一小部分暴露的肌肉，用中厚皮片覆盖。鞘内持续注射巴氯芬从未中断。三个月后，可通过手动轻松识别泵的补液部位以便进行泵补液。在2年的随访期内没有复发感染的迹象。
