Management of extravasation injuries: a retrospective study

Abstract

The extravasation of many agents during administration by way of the peripheral veins can produce severe necrosis of the skin and subcutaneous tissue. The incidence of an extravasation injury is elevated in the populations prone to complications, including the younger age groups. The severity of the necrosis depends on properties of the extravasated agent (vinca alkaloids, antracyclines, catecholamines, cationic solutions, osmotically active chemicals) including the type, concentration, and the quantity injected. In general, the primary diseases were chronic diseases such as hepatic or ischaemic encephalopathies, cardiac or pulmonary diseases, diabetes mellitus, and oncological diseases. The aim of this article was to explore the prevention, diagnosis, and treatment of extravasation injuries with a review of the literature. From January 2009 to August 2011, 22 patients were reviewed. Ten patients were children, and the others were adults. The surgical interventions were delayed until the development of the necrosis. A topical boric acid 3% solution was applied to all wounds with repetitive debridement. Debridement was performed once every 2 days and was continued until healthy tissue was obtained. The wounds of eight patients were repaired with split-thickness skin grafts, the wounds of six patients were reconstructed with randomised fasciocutaneous flaps, and the wounds of five patients healed by secondary intention. The wounds of three patients with massive swelling of the forearms were treated with only conservative modalities and limb elevation for 24-48 hours. Boric acid was found to promote granulation tissue in the wounds. The extravasation injuries can be prevented by using appropriate measures, such as the avoidance of perfusion under pressure, patient participation in pain follow-up, wound management by experienced health professionals, and preference for large and suitable veins.