[Early and late treatment of iatrogenic injection damage]

Extravasation injuries can result in extensive soft-tissue defects. On the cellular level there are five different pathophysiological mechanisms. Early treatment (surgical removal of the extravasated material within 24 h) and late treatment (debridement and coverage) are different. Thirty-two patients who suffered a significant extravasation were treated surgically by the Department of Plastic Surgery between 1989 and 1997. In 8 patients, referred within the first 24 h, the extravasated material could be removed by saline flushout. None of these patients developed soft-tissue defects or skin necrosis. The other 24 patients were referred late (mean 19 days after the injury). Patients with defects of the dorsum of the hand or cubital fossa area who underwent debridement, temporary wound coverage and skin grafting (n = 11) presented complete healing 52 days after the referral. Defects of the same regions covered by a flap after debridement (n = 6) healed within 14 days. The healing time of defects of the forearm (n = 2) and dorsum of the foot (n = 5) was a mean of 15 days after skin grafting. Cytotoxic and osmotically active substances should be removed by saline flushout within 24 h. In defects of the dorsum of the hand and cubital fossa, early debridement and coverage with an adequate flap should be performed.