A retrospective review of iatrogenic skin and soft tissue injuries

Abstract

Background: Even though the quality of medical and surgical care has improved remarkably over time, iatrogenic injuries that require surgical treatment including injuries caused by cast and elastic bandage pressure, extravasation, and dopamine-induced ischemia still frequently occur. The goal of this study was to estimate the incidence and analyze the distribution of iatrogenic injuries referred to our department.

Methods: A retrospective clinical review was performed from April 2006 to November 2010. In total, 196 patients (116 females and 80 males) were referred to the plastic surgery department for the treatment of iatrogenic injuries. We analyzed the types and anatomic locations of iatrogenic complications, along with therapeutic results.

Results: An extravasation injury (65 cases, 37.4%) was the most common iatrogenic complication in our study sample, followed by splint-induced skin ulceration, dopamine-induced necrosis, prefabricated pneumatic walking brace-related wounds and elastic bandage-induced wounds. Among these, prefabricated pneumatic walking brace-related complication incidence increased the most during the 5-year study period.

Conclusions: The awareness of the very common iatrogenic complications and its causes may allow physicians to reduce their occurrence and allow for earlier detection and referral to a plastic surgeon. We believe this is the first study to analyze iatrogenic complications referred to a plastic surgery department in a hospital unit.

Keywords: Extravasation of diagnostic and therapeutic materials; Medical errors; Pressure sore.

Fig. 1

Skin and soft tissue necrosis by extravasation injury (A) Skin and soft tissue necrosis caused by calcium gluconate extravasation. (B) At 6 months after flap surgery. The defect was covered using a reverse radial forearm island fasciocutaneous flap.

Fig. 2

Elastic bandage induced ulcer (A) Elastic bandage induced ulcer. Three-month-old infant with an ulcer on the left 3rd finger. (B) Ten days after local oxygen therapy. (C) Two months after the elastic bandage induced injury.

Fig. 3

Splint induced ulcer (A) Splint-induced ulcer of the heel. (B) Lateral malleolar perforator flap was used to cover the defect. (C) Six months after flap surgery.

Fig. 4

Dopamine-induced ischemia Dopamine-induced ischemia on (A) hand and (B) foot.

Fig. 5

Frequency of Iatrogenic Injuries most commonly reported to plastic surgeons