Treatment protocol for extravasation lesions

INTRODUCTION: Morbidity of tissue extravasations is far of being properly considered in our hospitals. The increased survival rate in very low prematures and severe oncological patients has also produced an increase in the incidence of this complication, that in the most of the cases are not agressively treated in order to minimize the extravasation consequences. We have reviewed our experience in the treatment of these lessions using either injection and saline flushing of the subcutaneous (Gault tissue protocol, 1993) or coverage with artificial dermis in cases with irreversible necrosis. PATIENTS AND METHODS: Between 1998 and 2004, 15 patients with a median age of 3 years (range 3 months- 12 years) were treated because of extravasation injuries. The extravasated solutions were: parenteral nutrition (7), calcium salts (4) and doxorrubicine (4). Ten patients (66%) were treated inmediately according to the Gault protocol. Seven out of the 10 did not suffer any cutaneous loss, and the remaining 3 had only minimal lessions. Debridement of inviable tissue and coverage with articial dermis after 2 or 3 weeks was made in 5 patients (33%). All of them obtained functional and esthetic satisfactory outcomes. CONCLUSIONS: Extravasation injuries must be early evaluated by the surgeon and treated inmediately using saline instilation and subcutaneous flushing. In severe cases with total skin necrosis, artificial dermis proporcionates good esthetic and functional results, similar to other complicated techniques, which are nor indicated in prematures or critical oncological patients.