Chirurgische Therapieoptionen nach Extravasaten systemischer Chemotherapie

Introduction

Extravasal application of chemotherapeutic agents may cause necrosis of the surrounding tissue. Often tendons, nerves and muscles are destroyed. In some cases, a surgical excision with additional coverage is indicated.

Surgical treatment

We report on 29 patients with necrosis after extravasation. In most cases, the lesion was localized to the hand or distal forearm, but the cubital fossa and thorax were also affected. Excision of the infiltrated tissue was performed and covered with local or free flaps, a split skin graft or primary closure.

Complications

Stable coverage was achieved in all cases. Patients with immunosuppression or comorbidity sometimes had wound healing difficulties. There were no important complications, such as flap necrosis, septicemia or infection.

Discussion

Chemotherapeutic extravasation is an important oncological complication that may cause permanent functional disability to the anatomical region involved. A variety of free and local flaps with tolerable donor morbidity can be used for coverage. Conservative treatment is often followed by a high rate of complications. Early radical debridement and coverage with an adequate flap offers a cure.