title: Subcutaneous wash-out procedure (SWOP) for the treatment of chemotherapeutic extravasations.
abstract: BACKGROUND
  Extravasations of chemotherapeutic drugs may lead to tissue necrosis and subsequent tissue defects, sometimes resulting in loss of function. In the absence of therapy, approximately one-third of vesicant extravasations will result in ulcerations, some of which necessitate plastic microsurgery to cover the soft tissue defects. The aim of this study was to describe the surgical technique itself and to present clinical results of the procedure in a clinical series of chemotherapeutic extravasation injuries that benefitted from a subcutaneous wash-out procedure (SWOP) by minimisation of serious complications.
  
  
  METHODS
  Over a time period of 3 years, we treated 13 female patients following chemotherapeutic extravasation injury. Nine of the cases involved a high vesicant chemotherapy agent, and four patients involved chemotherapy with low vesicant potential. The therapeutic approach was performed using SWOP exclusively without the application of specific antidotes.
  
  
  RESULTS
  The mean time interval between the extravasation injury and the SWOP was 345min (140-795min). In none of the cases was there a tissue breakdown, but there was a steady decrease in the inflammatory reaction of the cutaneous and subcutaneous soft tissues without additional complications over a 3-month follow-up period.
  
  
  CONCLUSIONS
  The results of the study suggest that SWOP is a minimally invasive, safe and effective emergency treatment for chemotherapeutic extravasation injury. Based on the absence of comparative studies with regard to the efficacy of conservative therapy, SWOP should be offered as a therapeutic option for chemotherapeutic extravasations, especially in cases of medical malpractice and also as a defence in case of a legal conflict.
authors.affiliation: Department of Plastic, Hand and Reconstructive Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30171 Hanover, Germany. steiert.andreas@mh-hannover.de
authors.forename: A
authors.initials: A
authors.lastname: Steiert
authors.forename: U
authors.initials: U
authors.lastname: Hille
authors.forename: W
authors.initials: W
authors.lastname: Burke
authors.forename: A
authors.initials: A
authors.lastname: Gohritz
authors.forename: S
authors.initials: S
authors.lastname: Zilz
authors.forename: C
authors.initials: C
authors.lastname: Herold
authors.forename: P M
authors.initials: PM
authors.lastname: Vogt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D040521:Subcutaneous Tissue / Q000187:drug effects*; D007507:Therapeutic Irrigation
chemical_list: D000970:Antineoplastic Agents