Plastic surgical management in tissue extravasation of cytotoxic agents inthe upper extremity

Extravasation injuries in subcutaneous tissues during peripheral intravenou s administration can result in extensive soft-tissue defects. Early treatme nt (surgical removal of the extravasated material within 24 h) and late tre atment (debridement and coverage) are two possible approaches for this kind of injury. Eighteen patients who suffered a significant extravasation inju ry were treated surgically between 1/1996 and 5/2001. All patients were ref erred late (mean 22 days after the event) to our clinic with soft-tissue de fects or skin necrosis and were accordingly only amenable to late treatment . The patients with defects over the dorsum of the hand, forearm or cubital fossa area underwent debridement, temporary wound coverage and skin grafti ng or coverage with a local flap. Spotted infiltrating lesions and necrosis are typical histologic features of a cytotoxic agent extravasation. A safe margin of resection is only achievable with a wide three dimensional excis ion. The healing time of defects was a mean of 15 days after either skin gr afting or flap coverage with no significant difference between the two diff ering treatment groups. Early referral of patients with extravasation injur ies to a specialized department for plastic and hand surgery may in future enable earlier surgical treatment, reduce time of illness and costs.