Surgical management of doxorubicin (Adriamycin) extravasation

The advent of potent chemotherapeutic agents has been helpful in the medical management of a variety of malignancies. Unfortunately, the side effects and complications have been significant. Our recent experience with a patient who had the avoidable complication of extravasation with doxorubicin (Adriamycin) into the upper extremity is described. Frequently, the medical management of this problem has been observation alone followed by late surgical referral. This tissue fixation of the chemotherapeutic agent is such that it stays bound locally and causes an ever enlarging ulceration of tissue. This slough can occur not only in a circumferential fashion, but also in the superficial to deep manner, resulting in full-thickness lesions. Early surgical intervention is important to shorten the morbidity and to return the patients to their home environment.