Use of subatmospheric pressure to prevent doxorubicin extravasation ulcersin a swine model

Application of subatmospheric pressure to sites injected with doxorubicin p revented ulcer formation in treated sites (0 ulcers/16 sites) compared to c ontrol wounds (10 ulcers/16 sites) in a pig model. Background and Objectives: Extravasation of doxorubicin hydrochloride (Adri amycin) frequently causes chronic ulcers, which usually progress and expose underlying structures such as tendons and bone. The exact mechanism of act ion that causes cell death and the chronic ulcers is unknown. Methods: Eight sites were injected intradermally with doxorubicin on each o f 4 pigs. Four sites on each animal served as untreated controls. The remai ning four sites were exposed to 125 mm Hg subatmospheric pressure applied 1 h after injection. The sites were observed on a three times per week sched ule. Sites that did not develop ulcers were re-injected up to a total of fo ur injections. The animals were observed for 5 weeks. Results: Ten of sixteen control sites developed ulcers. No subatmospheric p ressure treated sites developed ulcers. The incidence of ulcer formation wa s significantly less for treated wounds compared to control wounds at P < 0 .001 by Fisher's exact test. Conclusions: This physical modality appears to successfully prevent ulcer f ormation after doxorubicin injection. (C) 1999 Wiley-Liss, Inc.