Surgical treatment of ulcers caused by extravasation of cytotoxic drugs

Abstract

Despite preventive measures, the extravasation of cytotoxic drugs still occurs in 0.6% to 6% of cases. The aetiology is thought to be that tissue necrosis develops into a chronic ulcer, which causes problems if the harmful action of the drug is not blocked. From 1988-2002 at the Department of Plastic Surgery of Rome University "La Sapienza", 240 patients presented with extravasation of cytotoxic drugs; all had been treated with an original conservative protocol first described in 1994, based on the repeated local infiltration of a large quantity of saline solution (90-540 ml) into the area of extravasation. We considered only cases with actively necrotic lesions. Eleven of the 240 patients (5%) had ulcers ranging from small ulcers to extensive areas of tissue necrosis. Of the 11 patients, eight had already had ulcers, while the remaining three were those in whom our conservative protocol had not prevented necrosis. They were all operated on and given grafts, local flaps, reverse radial flaps, and free flaps.

Extravasation injuries: a review

“…No evidence of skin necrosis was noted in 13 patients undergoing this treatment at an average 345 (range 140–795) min post-chemotherapy extravasation (Steiert et al, 2011). D’Andrea et al (2004) successfully used repeated saline infiltration into the extravasation area (without flushing or aspirating) to dilute chemotherapeutic agents with only three out of 229 patients developing ulceration. Late washout may be effective, so could still be considered even after days have passed after the injury (Dionyssiou et al, 2011).…”