title: Port-a-Cath extravasation of vesicant cytotoxics: surgical options for a rare complication of cancer chemotherapy.
abstract: BACKGROUND
  Although implantation of a central venous device such as a Port-a-Cath was initially considered safe, extravasation rates up to 4.7% have been reported. Therefore, the objective of this study was to propose a structured procedure for the management of extravasation of a cytotoxic treatment.
  
  
  METHODS
  A total of eight patients were evaluated after port extravasation of epirubicin (n = 3), platinum compounds (n = 3), paclitaxel (n = 1), or trabectedin (n = 1) into the subcutaneous space. Immediate explantation of the port was performed in combination with a "Subcutaneous Wash-Out Procedure" (SWOP). When removal of the port was delayed, débridement and flap coverage were performed as necessary. Epirubicin concentrations present in the samples obtained during surgical intervention were subsequently analysed using high-performance liquid chromatography (HPLC). Patients were followed for at least six months and were examined for sequelae such as pain, induration, redness, and limited movement.
  
  
  RESULTS
  All three patients whose extravasation event was detected during chemotherapy administration benefited from SWOP with acceptable side effects (e.g., erythema). The analysis of epirubicin concentrations demonstrated the active removal of relevant amounts of the compound by wound rinsing. In contrast, late detection of extravasation led to major débridement and flap coverage in four out of five patients. A high body mass index (BMI) value was associated with all of the patients that experienced port extravasation.
  
  
  CONCLUSIONS
  Depending on when Port-a-Cath extravasations into subcutaneous tissue are detected, different treatments are appropriate. When extravasation is detected early, the SWOP was found to be beneficial.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Haslik
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Hacker
authors.affiliation: Department of Surgery, Division of General Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Austria.
authors.forename: F X
authors.initials: FX
authors.lastname: Felberbauer
authors.affiliation: Department of Medicine I, Comprehensive Cancer Center of the Medical University of Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Thallinger
authors.affiliation: Department of Medicine I, Comprehensive Cancer Center of the Medical University of Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Bartsch
authors.affiliation: Department of Pathology, Comprehensive Cancer Center of the Medical University of Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Kornauth
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Deutschmann
authors.affiliation: Department of Medicine I, Comprehensive Cancer Center of the Medical University of Vienna, Austria. Electronic address: robert.mader@meduniwien.ac.at.
authors.forename: R M
authors.initials: RM
authors.lastname: Mader
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015992:Body Mass Index; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D020878:Device Removal / Q000379:methods*; D004149:Dioxoles / Q000008:administration & dosage / Q000009:adverse effects; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D004868:Equipment Failure; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D000077150:Oxaliplatin; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D013524:Surgical Flaps; D044005:Tetrahydroisoquinolines / Q000008:administration & dosage / Q000009:adverse effects; D007507:Therapeutic Irrigation; D000077606:Trabectedin; D062666:Vascular Access Devices; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D004149:Dioxoles; D009944:Organoplatinum Compounds; D044005:Tetrahydroisoquinolines; D000077150:Oxaliplatin; D015251:Epirubicin; D000077606:Trabectedin; D017239:Paclitaxel; D002945:Cisplatin
keywords: Epirubicin; Extravasation; Port-a-Cath(®); Subcutaneous Wash-Out Procedure; Vesicant