Emergency evacuation low-pressure suction for the management of extravasation injuries - a case report

Extravasation is the movement of fluid outside its conduit into the extracellular tissue, possibly leading to a local inflammatory reaction, compartment syndrome, tissue necrosis, and full thickness skin loss at the affected area. To prevent these complications, early recognition, referral and treatment of an extravasation injury is of utter importance.

We present a case, illustrating an extravasation injury into the breast managed by a renovated surgical technique - emergency evacuation low-pressure suction (EELS). A 54-year-old woman attended the emergency department with 1.5 L of total parenteral nutrition leaked into her right breast via a central portal catheter. The patient was seen within 24 hours of the incident, and presented with a diffuse swollen, tender and erythematous right breast but no overlying skin necrosis. Dry EELS via two small stab incisions was performed to evacuate the extravasated total parenteral nutrition and to minimise the aspiration of healthy fat tissue of the breast. Only a few cases of extravasation injuries into the breast have been described and most cases involve chemotherapy extravasation from a central catheter. Presumably there is an underreporting of this complication in the literature.

This case-report promotes the use of aspiration in the management of diffusely spread extravasated injuries. EELS is a more appropriate term than liposuction, as there is no intention to evacuate healthy fat tissue. This new term is less confusing and might help medical staff and patients to better understand the treatment as it will break the affiliation with an aesthetic procedure. It is an effective and cosmetically satisfactory technique to treat early total parenteral nutrition extravasation injury at the level of the breast.