Hand reconstruction after chemotherapy drug extravasation

Abstract

Background and objective: Extravasation means the inappropriate or accidental infiltration of chemotherapy drugs into the subcutaneous tissue or subdermal tissues surrounding the administration site. These injuries range from less significant erythematous reactions to skin sloughing and necrosis. Extravasation frequency in adults is considered to be between 0.1%-6% of peripheral infusions and 0.3%-4.7% of implanted central venous access device infusions. " Material and methods: We represent two hand reconstruction cases after chemotherapy drug extravasation and soft tissues ulceration. Both females with maligned lymphoma diagnosis got several chemotherapy treatment courses. Plastic surgeon consultation after 4 and 6 months respectively post ulceration appeared. " Necrectomy procedures and soft tissue reconstruction of the damaged hand with free latissimus dorsi/serratus anterior muscle flap covered with spit thickness skin graft were performed. After one month post operation patients underwent hand rehabilitation: physiotherapy, scar reducing procedures, exercises for increasing joint movement amplitude. " Results and conclusions: Following extravasation of chemotherapeutic drug, the ulceration treatment with free muscle flap covered with partial thickness skin graft seen as an alternative to other reconstruction methods (for exp. radial arm flap). " Chosen reconstruction method allows achieving good treatment results, satisfactory aesthetic appearance of the hand, the possibility of extensor tendons reconstruction and damaged joints arthroplasty. " Early diagnosis and appropriate treatment of extravasation reduces the risk of the damaged area ulceration and functional impairment.