Subfascial expansive plasty for intrathecal baclofen pump replacement. A technical note.

PURPOSE: Although intratechal pump replacement is a common technique, it can be sometimes complicated when aiming to replace a 20 ml pump with a bigger one (40 ml). We developed a simple and straightforward technique to relax the wall of the pocket of the pump, preserving its fascial layer.

METHODS: A 20-year-old boy with spastic tetraparesia was admitted for pump replacement. After scar opening and pump removal, various lineal incisions were performed in the posterior layer of the subfascial pocket in a cranio-caudal direction.

RESULTS: A 40 ml pump was placed without skin incision ampliation and preserving subfascial plane.

CONCLUSIONS: This easy, expansive technique for infusion pump replacement preserves subfascial plane and prevents the need for more extensive surgeries.