Cytostatic extravasations

Sixty-six cases of cytostatic extravasation referred to a plastic surgery department between 1977 and mid-1985 are discussed. Doxorubicin was the most common drug involved, but a number of other drugs also caused lesions requiring surgical intervention. Operative treatment, consisting of excision of drug-infiltrated tissue followed by skin transplantation, was performed in half the patients. Significant residual damage was seen in 12 patients who had all received the drug at the elbow joint, wrist, or back of the hand. Fourteen patients were operated on late in the course of the disease, on average 10 weeks after the accident because of delayed referral. In 1983 prophylaxis was undertaken and first-aid treatment was administered, consisting of aspiration via the administration catheter. The nature of patient referrals then improved considerably. It is recommended that cytostatic treatment be given at the antebrachium, if possible, and that aspiration be attempted promptly after an accident. Manifest lesions should be operated on early, i.e., within the first week. The indication for early operation is particularly strong if a highly irritative drug has been deposited in a critical region and has caused a severe local reaction.