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

Area of Science:

• Paediatric Plastic Surgery
• Vascular Access Complications
• Tissue Injury Management

Background:

• Extravasation, the leakage of intravenous fluids into surrounding tissues, is a common and potentially damaging complication in pediatric patients.
• These injuries can lead to significant tissue damage, including ulceration and partial or full-thickness skin loss.
• The effectiveness of a washout procedure in mitigating these outcomes requires further investigation.

Purpose of the Study:

• To evaluate the efficacy of a washout procedure in reducing the incidence of skin loss following extravasation injuries in children.
• To identify predictors of skin loss in paediatric extravasation injuries.
• To inform clinical practice regarding the management of extravasation injuries.

Main Methods:

• Prospective review of paediatric extravasation injuries managed by the Plastic and Maxillofacial Department over five years.
• Data collection included patient demographics, extravasated fluid characteristics, injury severity (grade), anatomical location, and timing of washout.
• Logistic regression analysis was employed to determine predictors of skin loss at 24 and 48 hours post-injury.

Main Results:

• A total of 216 injuries were analyzed; 16.7% resulted in skin loss.
• Lower limb site, grade 3, and grade 4 injuries were significant predictors of skin loss.
• Absence of washout markedly increased the risk of skin loss, particularly for severe (grade 3 and 4) injuries.

Conclusions:

• The washout procedure is an effective intervention for preventing skin loss in paediatric extravasation injuries, especially for grades 3 and 4.
• Injuries involving the lower limb have a higher risk of skin loss.
• Clinical management should prioritize urgent washout intervention guided by the injury grade.