RÉSUMÉ
Intrathecal baclofen (ITB) therapy is used to treat patients with spasticity. The pump that delivers baclofen to the intrathecal space of the thoracolumbar spine is generally implanted under the skin or fascia of the anterolateral abdomen. Here we present a case in which the pump was implanted in an alternative site, under the skin of the anteromedial thigh. The patient was a 61-year-old man who was 148 cm tall. He had spastic paraplegia (ASIA Impairment Scale grade B) caused by severe scoliosis related to dystrophic neurofibromatosis. No safety space for pump implantation existed in his abdomen because of a stoma, scars, and adhesions that resulted from surgeries for ileus and abdominal aortic aneurysms. The catheter ran from the lumbar spine to the anteromedial thigh via the point between the iliac crest and the great trochanter. The catheter and pump caused no trouble over 1 year of follow-up. This case demonstrates that the thigh can be an alternative site for ITB pump implantation in some patients with abdominal wall problems. This surgical modification may not be indicated for some patients with ambulators or frequent hip motion, who are at risk of catheter problems or pump migration.
RÉSUMÉ
Intrathecal baclofen (ITB) therapy is used to treat patients with spasticity. The pump that delivers baclofen to the intrathecal space of the thoracolumbar spine is generally implanted under the skin or fascia of the anterolateral abdomen. Here we present a case in which the pump was implanted in an alternative site, under the skin of the anteromedial thigh. The patient was a 61-year-old man who was 148 cm tall. He had spastic paraplegia (ASIA Impairment Scale grade B) caused by severe scoliosis related to dystrophic neurofibromatosis. No safety space for pump implantation existed in his abdomen because of a stoma, scars, and adhesions that resulted from surgeries for ileus and abdominal aortic aneurysms. The catheter ran from the lumbar spine to the anteromedial thigh via the point between the iliac crest and the great trochanter. The catheter and pump caused no trouble over 1 year of follow-up. This case demonstrates that the thigh can be an alternative site for ITB pump implantation in some patients with abdominal wall problems. This surgical modification may not be indicated for some patients with ambulators or frequent hip motion, who are at risk of catheter problems or pump migration.
RÉSUMÉ
Objective To investigate the therapeutic effect of modified dorsal metacarpal artery island flap of index finger without skin graft in repairing different types of soft tissue defect of thumb tip.Methods From August,2015 to October,2017,25 patients with soft tissue defect of the thumb tip were included in the study.Sixteen cases were males and 9 cases were females.Seventeen defects were in thumb dorsal and 8 cases were in thumb pulp.A modified dorsal island flap of index finger was used and the dorsal metacarpal superficial vein fascial flap could be harvest and combined to repair the thumb pulp defect if necessary.A relaying perforator flap pedicled on the second dorsal metacarpal artery was raised through the same incision to cover the donor site without skin graft.Followed-up was made by clinic,telephone and WeChat.Results The patients were followed-up for 6 to 18 months.All flaps survived completely without complications.The color,texture and contour of the flaps was good.Only 1 linear scar was left in the dorsum of the hand and no skin grafts.The second dorsal metacarpal artery flap was used to cover the donor site.Twenty-one cases (84％) were satisfied with the postoperative appearance of the thumb.The function was assessed as excellent in 16 fingers,good in 6 fingers and fair in 3 fingers.No complication occurred in the donor site.Conclusion It is possible to use the modified dorsal island flap of index finger to repair different types of thumb tip defects.A second dorsal metacarpal artery flap can be used as a relaying flap to cover the donor site without skin grafts.