{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:32:45Z","timestamp":1755225165534,"version":"3.43.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T00:00:00Z","timestamp":1736899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Burn injuries in patients with significant preexisting medical conditions provide unique challenges in both medical management and surgical planning. Spasticity, if left untreated, can be one of the most disabling consequences of a neurologic injury. Treatment is largely dependent on pharmacologic management with antispasmodic agents such as baclofen. Baclofen\u2019s effectiveness when taken orally is often limited by its systemic side effects, which mostly affect the CNS. Intrathecal baclofen (ITB) can circumvent these intolerable adverse effects while achieving symptom relief via a more targeted therapeutic route. However, abrupt cessation of chronic baclofen use can precipitate an acute life-threatening withdrawal syndrome. We present a case of a 47-year-old female who sustained 54% TBSA full-thickness flame burns to the circumferential bilateral lower extremities, left arm, left anterior and posterior trunk, flank, and perineum. She had a premorbid C5 spinal cord injury resulting in spastic paraplegia for which she had an ITB pump implanted into her left abdominal wall for symptom management. This pump was directly beneath her operative burn wounds. We discuss the complex issues that were encountered throughout her care related to medication reservoir supply, life-threatening risk of baclofen withdrawal, pain-specialist availability, medical-legal barriers, and the multi-staged surgical plan for coverage, balancing proper wound debridement with risk of device exposure and infection. To our knowledge, this is the only case report detailing the cohort of obstacles that may be associated with these devices, specifically with burn patients.<\/jats:p>","DOI":"10.1093\/jbcr\/irae210","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T15:25:10Z","timestamp":1736781910000},"page":"656-667","source":"Crossref","is-referenced-by-count":0,"title":["Intrathecal Baclofen Pump Wean and Risk of Exposure in a Large Total Body Surface Area Burn Wound Patient: A Case Report"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4392-6359","authenticated-orcid":false,"given":"Lauren A","family":"Lautenslager","sequence":"first","affiliation":[{"name":"Division of Plastic Surgery, Indiana University , Indianapolis, IN ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9467-6938","authenticated-orcid":false,"given":"Melissa E","family":"Cullom","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University , Indianapolis, IN ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6416-3042","authenticated-orcid":false,"given":"Deidra B","family":"Bedgood","sequence":"additional","affiliation":[{"name":"Richard M. Fairbanks Burn Center, Eskenazi Heath , Indianapolis, IN ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9412-5899","authenticated-orcid":false,"given":"Allison N","family":"Boyd","sequence":"additional","affiliation":[{"name":"Richard M. Fairbanks Burn Center, Eskenazi Heath , Indianapolis, IN ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7531-0132","authenticated-orcid":false,"given":"Leigh J","family":"Spera","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University , Indianapolis, IN ,","place":["United States"]},{"name":"Richard M. Fairbanks Burn Center, Eskenazi Heath , Indianapolis, IN ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,1,15]]},"reference":[{"key":"2025081301370251800_CIT0001","article-title":"Spasticity","volume-title":"StatPearls [Internet]","author":"Rivelis","year":"2025"},{"key":"2025081301370251800_CIT0002","doi-asserted-by":"publisher","first-page":"354906","DOI":"10.1155\/2014\/354906","article-title":"Pathophysiology of spasticity: implications for neurorehabilitation","volume":"2014","author":"Trompetto","year":"2014","journal-title":"Biomed Res Int"},{"key":"2025081301370251800_CIT0003","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1055\/s-0034-1396012","article-title":"Spasticity and intrathecal baclofen","volume":"34","author":"Furr-Stimming","year":"2014","journal-title":"Semin Neurol"},{"key":"2025081301370251800_CIT0004","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1177\/088307389601100202","article-title":"Baclofen in the treatment of cerebral palsy","volume":"11","author":"Albright","year":"1996","journal-title":"J Child Neurol"},{"key":"2025081301370251800_CIT0005","doi-asserted-by":"publisher","first-page":"4315","DOI":"10.1021\/jm701425k","article-title":"Synthesis and pharmacological evaluation of novel gamma-aminobutyric acid type B (GABAB) receptor agonists as gastroesophageal reflux inhibitors","volume":"51","author":"Alstermark","year":"2008","journal-title":"J Med Chem"},{"key":"2025081301370251800_CIT0006","first-page":"1","article-title":"Intrathecal baclofen pump for spasticity: an evidence-based analysis","volume":"5","author":"Medical Advisory Secretariat","year":"2005","journal-title":"Ont Health Technol Assess Ser"},{"key":"2025081301370251800_CIT0007","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1177\/106002808501900415","article-title":"Adverse effects secondary to baclofen withdrawal","volume":"19","author":"Garabedian-Ruffalo","year":"1985","journal-title":"Drug Intell Clin Pharm"},{"key":"2025081301370251800_CIT0008","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1093\/jbcr\/irz200","article-title":"Risk factors and prevalence of QTc prolongation in adult burn patients receiving methadone","volume":"41","author":"Walroth","year":"2020","journal-title":"J Burn Care Res"},{"volume-title":"Product monograph for LIORESAL","author":"Novartis Pharmaceuticals Canada Inc","key":"2025081301370251800_CIT0009"},{"key":"2025081301370251800_CIT0010","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1001\/archsurg.137.9.1049","article-title":"Effects of delayed wound excision and grafting in severely burned children","volume":"137","author":"Xiao-Wu","year":"2002","journal-title":"Arch Surg"},{"key":"2025081301370251800_CIT0011","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1097\/01.PRS.0000041445.76730.23","article-title":"Effects of burn wound excision on bacterial colonization and invasion","volume":"111","author":"Barret","year":"2003","journal-title":"Plast Reconstr Surg"},{"key":"2025081301370251800_CIT0012","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/0305-4179(85)90036-1","article-title":"A policy of early excision and grafting in elderly burn patients shortens the hospital stay and improves survival","volume":"12","author":"Deitch","year":"1985","journal-title":"Burns Incl Therm Inj"},{"key":"2025081301370251800_CIT0013","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/s0039-6109(16)44135-6","article-title":"Early burn excision and grafting","volume":"67","author":"Heimbach","year":"1987","journal-title":"Surg Clin North Am"},{"key":"2025081301370251800_CIT0014","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/0305-4179(94)90109-0","article-title":"The effect of early surgical intervention on mortality and cost-effectiveness in burn care, 1978-91","volume":"20","author":"Munster","year":"1994","journal-title":"Burns"},{"key":"2025081301370251800_CIT0015","doi-asserted-by":"publisher","first-page":"20503121211022197","DOI":"10.1177\/20503121211022197","article-title":"Baclofen therapeutics, toxicity, and withdrawal: a narrative review","volume":"9","author":"Romito","year":"2021","journal-title":"SAGE Open Med"},{"key":"2025081301370251800_CIT0016","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1111\/ner.12467","article-title":"Best practices for intrathecal baclofen therapy: troubleshooting","volume":"19","author":"Saulino","year":"2016","journal-title":"Neuromodulation"}],"container-title":["Journal of Burn Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jbcr\/advance-article-pdf\/doi\/10.1093\/jbcr\/irae210\/61442615\/irae210.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbcr\/article-pdf\/46\/3\/656\/61442615\/irae210.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbcr\/article-pdf\/46\/3\/656\/61442615\/irae210.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T05:37:12Z","timestamp":1755063432000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbcr\/article\/46\/3\/656\/7954469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,15]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,1,15]]},"published-print":{"date-parts":[[2025,8,12]]}},"URL":"https:\/\/doi.org\/10.1093\/jbcr\/irae210","relation":{},"ISSN":["1559-047X","1559-0488"],"issn-type":[{"type":"print","value":"1559-047X"},{"type":"electronic","value":"1559-0488"}],"subject":[],"published-other":{"date-parts":[[2025,5]]},"published":{"date-parts":[[2025,1,15]]}}}