Skin Necrosis Following Extravasation Injury: A 5-Year Experience in a Tertiary Paediatric Centre

Extravasation is the leakage of intravenous drugs, chemicals, or fluids into the extravascular compartment and is common in paediatric patients. These injuries can cause ulceration with tissue loss. This study investigates whether a washout procedure can reduce the incidence of partial- or full-thickness skin loss following extravasation.

All extravasation injuries referred to the Plastic and Maxillofacial Department at the Royal Children's Hospital, Melbourne, from June 2018 to June 2023 were prospectively identified and reviewed. Data collected included patient demographics, extravasated fluid potency, injury grade, anatomical site, washout timing, and outcomes at 24 and 48 h. Logistic regression was used to identify predictors of skin loss.

A total of 216 extravasation injuries were analysed; 61.1% were male, and 41.7% were under 1 year old. Washout was performed in 50.5% of cases, and 16.7% developed skin loss. Multivariate analysis identified lower limb site (OR = 7.46; p = 0.008), grade 3 injury (OR = 193.10; p < 0.001), and grade 4 injury (OR = 441.30; p < 0.001) as strong predictors of skin loss. Absence of washout significantly increased the risk (OR = 7.51; p = 0.018), particularly in grade 3 and 4 injuries (OR = 15.48; p = 0.003). Fluid potency and age were not independent predictors after adjusting for confounders.

Washout is effective for reducing skin loss in paediatric extravasation injuries, particularly in grades 3 and 4. Lower limb cannulation carries a significantly higher risk of skin loss. Injury grade should guide urgent washout intervention.