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A method for reducing the pocket complications of the internal infusion pumps in pediatric patients: a case report

L Marugán1, E Revuelta, E Lorda

  • 1Departments of Anesthesiology Pain Relief Unit, and Surgery, Marina Baixa Hospital, Villajoyosa, Alicante, and Department of Plastic Surgery, General University Hospital, Alicante, Spain.

Neuromodulation : Journal of the International Neuromodulation Society
|December 14, 2011
PubMed

Insights

A novel surgical technique using a subcutaneous expander creates a suitable pocket for internal infusion pumps in pediatric patients. This method addresses volume discrepancies, potentially expanding pump use in children.

Area of Science:

  • Neurosurgery
  • Pediatric Surgery
  • Biomedical Engineering

Background:

  • Internal infusion pumps offer safe drug delivery in adults but pose challenges in pediatric populations due to abdominal wall size discrepancies.
  • A significant contraindication for pediatric pump implantation is the mismatch between pump volume and the patient's abdominal wall dimensions.
  • Baclofen therapy is crucial for managing spasticity in conditions like cerebral palsy.

Purpose of the Study:

  • To describe a novel method for preparing a subcutaneous pocket for intrathecal infusion pump implantation in a pediatric patient.
  • To overcome the anatomical limitations in pediatric patients for safe and effective internal infusion pump therapy.
  • To evaluate the feasibility of using a subcutaneous expander to create a well-fitted pump pocket.

Main Methods:

  • A subcutaneous tissue expander with a saline reservoir was inserted into the abdominal wall of a 10-year-old cerebral palsy patient.
  • The reservoir was weekly filled with saline solution over three sessions to gradually expand the tissue.
  • This process created a soft, appropriately sized pocket, minimizing tissue tension and risk of pressure sores prior to pump implantation.

Main Results:

  • A subcutaneous pocket, suitable for an internal infusion pump, was successfully created using the expander technique.
  • The resulting pocket exhibited soft shaping without sharp edges, reducing the risk of pressure sores and tissue tension.
  • The method demonstrated a viable approach to accommodate internal infusion pumps in pediatric patients.

Conclusions:

  • This tissue expansion technique provides a safe and effective method for preparing pump pockets in pediatric patients.
  • It addresses the anatomical challenges previously limiting the use of internal infusion pumps in younger populations.
  • The described method holds potential to broaden the application of internal infusion pumps for various therapies in children.

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