Surgical treatment of extravasation injuries: experience of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo.

Dimas André Milcheski,Araldo Ayres Monteiro Júnior,Wellington Menezes Mota,Rolf Gemperli,Rodolfo Costa Lobato

doi:10.1590/0100-6991e-20181912

Dimas André Milcheski, Araldo Ayres Monteiro Júnior + Show 3 more

Open Access

https://doi.org/10.1590/0100-6991e-20181912

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Abstract

to report the experience of the Division of Plastic Surgery of the Hospital das Clínicas of the Medical School of the University of São Paulo in the treatment of cutaneous lesions due to accidental extravasation of drugs. we included patients with lesions due to extravasation of drugs over a period of 18 months. We retrospectively evaluated the following parameters: age, diagnoses during hospitalization and comorbidities, serum levels of albumin and hemoglobin, place of hospitalization, drug involved, anatomic segment affected, therapeutic management and death during hospitalization. we followed-up 14 patients. The main drug involved was noradrenaline (21%). All patients underwent debridement of tissue necrosis. Three patients were submitted to flaps after preparation of the wound bed with negative pressure therapy, with good results. Seven patients had no definitive treatment of their lesions due to lack of clinical conditions. in patients with favorable clinical conditions, the definitive treatment with flaps was adequate for cases of wounds due to extravasation of drugs in the subcutaneous tissue when there was exposure of noble structures.

Highlights

Injury due to extravasation of drugs is the major cause of iatrogenic morbidity in the hospital environment[1]
This paper aims to report the experience of the Division of Plastic Surgery of the Hospital das Clínicas of the Medical School of the University of São Paulo (HC-FMUSP) in the treatment of cutaneous lesions due to accidental extravasation of drugs
830 referrals for evaluation of wounds in the complex of the HC-FMUSP were analyzed by the Plastic Surgery Service, totaling 14 patients with injuries resulting from extravascular extravasation of drugs, with incidence in our sample of 1.6%

Summary

Introduction

Injury due to extravasation of drugs is the major cause of iatrogenic morbidity in the hospital environment[1] The incidence of this event in the literature from varies 0.1% to 6% in adult patients and from 11% to 70%, in children[2,3]. Patients at extremes of age, neonates and the elderly, are at greater risk of injury by extravasation, in addition to individuals with altered levels of consciousness or sedated, who are unable to express pain[4]. This is an event that generates a high cost for the health system, involving expenses of around US$.66,000.00 due to lawsuits in the United States[5]. This is due to pain, difficulty in mobility, limitation of daily activities, permanent nerve damage, loss of limbs and, in some cases, death[1]

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