title: Fluorescence microscopic demonstration and demarcation of doxorubicin extravasation. Experimental and clinical studies.
abstract: Extravasation of doxorubicin and its derivative epirubicin, cause severe progressive tissue necrosis that requires early excision of all affected tissues. Doxorubicin and epirubicin are autofluorescent and this characteristic can be used to demonstrate and delineate extravasation by the aid of fluorescence microscopic study. In a rat model doxorubicin was injected intradermally in declining concentrations and the minimal detectable concentration was found to be 0.02 mg/ml. Skin necrosis developed in rats injected with doxorubicin concentrations ranging from 0.02 mg/ml to 2 mg/ml. Clinically, fluorescence microscopic analysis of frozen sections was used in eight patients to assess whether doxorubicin or epirubicin extravasation had taken place. When all fluorescing tissue was removed, no necrosis ensued, but in one patient, where a slightly fluorescing area was ignored, necrosis developed later and excision of the tissue had to be performed.
authors.affiliation: Department of Reconstructive Surgery, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: K K
authors.initials: KK
authors.lastname: Dahlstrøm
authors.forename: H L
authors.initials: HL
authors.lastname: Chenoufi
authors.forename: S
authors.initials: S
authors.lastname: Daugaard
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects*; D015251:Epirubicin / Q000009:adverse effects; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications*; D005260:Female; D006801:Humans; D007271:Injections, Intradermal; D007275:Injections, Intravenous; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D009132:Muscles / Q000187:drug effects / Q000473:pathology; D009336:Necrosis; D051381:Rats; D011919:Rats, Inbred Strains; D012867:Skin / Q000187:drug effects* / Q000473:pathology
chemical_list: D015251:Epirubicin; D004317:Doxorubicin