title: Surgical treatment of ulcers caused by extravasation of cytotoxic drugs.
abstract: Despite preventive measures, the extravasation of cytotoxic drugs still occurs in 0.6% to 6% of cases. The aetiology is thought to be that tissue necrosis develops into a chronic ulcer, which causes problems if the harmful action of the drug is not blocked. From 1988-2002 at the Department of Plastic Surgery of Rome University "La Sapienza", 240 patients presented with extravasation of cytotoxic drugs; all had been treated with an original conservative protocol first described in 1994, based on the repeated local infiltration of a large quantity of saline solution (90-540 ml) into the area of extravasation. We considered only cases with actively necrotic lesions. Eleven of the 240 patients (5%) had ulcers ranging from small ulcers to extensive areas of tissue necrosis. Of the 11 patients, eight had already had ulcers, while the remaining three were those in whom our conservative protocol had not prevented necrosis. They were all operated on and given grafts, local flaps, reverse radial flaps, and free flaps.
authors.affiliation: Plastic Surgery Department, Second University of Naples, Naples, Italy. francesco.dandrea@unina2.it
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Andrea
authors.forename: Maria Giuseppina
authors.initials: MG
authors.lastname: Onesti
authors.forename: Giovanni Francesco
authors.initials: GF
authors.lastname: Nicoletti
authors.forename: Elisa
authors.initials: E
authors.lastname: Grella
authors.forename: Luca Francesco
authors.initials: LF
authors.lastname: Renzi
authors.forename: Cristina
authors.initials: C
authors.lastname: Spalvieri
authors.forename: Nicolò
authors.initials: N
authors.lastname: Scuderi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods*; D012883:Skin Ulcer / Q000139:chemically induced* / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D034941:Upper Extremity; D014945:Wound Healing / Q000502:physiology