BACKGROUND AND OBJECTIVES Intrathecal drug therapy is a common treatment for dystonia, pain, and spasticity using implanted pump and catheter systems. Standardized management of intrathecal drug pump (ITDP) migration and flipping has not been well established in the literature. This study reports the use of soft tissue to address less common pump complications such as pump flipping, migration, and difficulty in medication refill. METHODS A retrospective chart review of intrathecal pump cases performed by two surgeons between February 2020 and August 2022 was conducted. Patients with complications such as pump flipping, migration, or challenges in medication refill treated with soft tissue flaps were included. Patient demographics, comorbidities, and perioperative data were collected. RESULTS A total of five patients with ITDP complicated by pump flipping, migration, malposition, or difficulty in medication refill that were treated using fascial flaps were included in the study. Three technical considerations when revising ITDP complications are secure pump anchoring, reliable wound closure, and ease of pump medication refill. Cases 1 and 2 demonstrate the technique of secure pump anchoring with a rectus fascial flap. Cases 3 and 4 show a technique to achieve reliable vascularized wound closure, and case 5 describes a technique to solve an uncommon problem of a thick subcutaneous abdominal tissue preventing the refill of the ITDP medication. CONCLUSION Soft tissue flaps may serve as a treatment option for patients with uncommon ITDP complications. De-epithelialized dermal fasciocutaneous or fascial flaps may be developed to anchor the pump more securely. Cross-discipline collaboration may further delineate the technique, benefits, and outcomes of this approach.

中文翻译：

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使用筋膜瓣治疗鞘内药泵翻转：技术说明和案例系列。

背景和目标 鞘内药物治疗是使用植入泵和导管系统治疗肌张力障碍、疼痛和痉挛的常见方法。文献中尚未建立鞘内药物泵（ITDP）迁移和翻转的标准化管理。这项研究报告了使用软组织来解决不太常见的泵并发症，例如泵翻转、迁移和药物补充困难。方法 对 2020 年 2 月至 2022 年 8 月期间两名外科医生进行的鞘内泵病例进行回顾性图表审查。患有泵翻转、移位或软组织瓣治疗药物补充困难等并发症的患者也被纳入其中。收集患者人口统计学、合并症和围手术期数据。结果 本研究共纳入 5 例因泵翻转、移位、错位或药物补充困难而接受筋膜瓣治疗的 ITDP 患者。修改 ITDP 并发症时的三个技术考虑因素是泵的安全锚定、伤口闭合的可靠以及泵药物补充的方便性。案例 1 和案例 2 展示了使用直肌筋膜瓣进行安全泵锚定的技术。案例 3 和案例 4 展示了一种实现可靠的血管化伤口闭合的技术，案例 5 描述了一种解决不常见问题的技术，即厚厚的腹部皮下组织阻碍了 ITDP 药物的补充。结论 软组织瓣可作为罕见 ITDP 并发症患者的一种治疗选择。可以开发去上皮的真皮筋膜皮瓣或筋膜瓣，以更牢固地锚定泵。跨学科合作可以进一步描述这种方法的技术、好处和结果。