Management of pediatric extravasation injuries with NPWT

Summary

Extravasations injuries are common in pediatric population most frequently in neonatal intensive care units. Accidental infusion leakage into the subcutaneous tissue may lead to skin necrosis and can cause long-term scarring with cosmetic and functional implications. Extravasation of calcium gluconate is often less frequent and most articles reported isolated clinical cases. Injuries are often severe and negative pressure wound therapy is useful for the management.

We report two cases, a neonate and a 15-year-old adolescent with severe injuries to the back of hand and forearm. Erythema and swelling were very important for the two patients and skin necrosis appeared and required debridement three weeks after extravasation. The neonate presented white papules with subcutaneous calcifications revealed by radiographs and calcinosis cutis was diagnosed. Subcutaneous tissue still presented swelling and poor vascularization which was not efficient for good healing. Functional positions with orthosis were difficult according to swelling. We used NPWT for reducing swelling and optimizing tissue before coverage procedure. Skin graft was performed at day 30 and 35, and healing was achieved.

Subcutaneous calcium solutions lead to signs of inflammation and often severe swelling several days after extravasation. Significant risk of skin necrosis is observed and depends of concentration, volume, duration of infiltration of agent and increased in neonate population. There’s no consensus on management but recently several authors in the literature advocated early treatment with aspiration and washout techniques to dilute and remove the infused agent. If there is evidence of necrosis, debridement and coverage with skin graft or flap must be performed but can be impaired by the importance of swelling and local vascularization. NPWT can improve local conditions for good healing. Progressive clearing of tissue calcification occurred with no evidence at 6 months. Long-term scars remained with cosmetic and functional implications.

In conclusion, extravasation injuries are iatrogenic accidents. Prevention and early treatment are the best management. Calcic solutions can lead to severe tissue damage with skin necrosis and swelling which required surgery. NPWT can optimize this treatment.

Authors

Marie-Christine Plancq
Chu d' Amiens, Department of pediatric surgery, Amiens, France

Celine Klein
Chu d' Amiens, Department of pediatric surgery, Amiens, France

Francois Deroussen
Chu d' Amiens, Department of pediatric surgery, Amiens, France

Richard Gouron
Chu d' Amiens, Department of pediatric surgery, Amiens, France

Summary

Extravasations injuries are common in pediatric population most frequently in neonatal intensive care units. Accidental infusion leakage into the subcutaneous tissue may lead to skin necrosis and can cause long-term scarring with cosmetic and functional implications. Extravasation of calcium gluconate is often less frequent and most articles reported isolated clinical cases. Injuries are often severe and negative pressure wound therapy is useful for the management.

We report two cases, a neonate and a 15-year-old adolescent with severe injuries to the back of hand and forearm. Erythema and swelling were very important for the two patients and skin necrosis appeared and required debridement three weeks after extravasation. The neonate presented white papules with subcutaneous calcifications revealed by radiographs and calcinosis cutis was diagnosed. Subcutaneous tissue still presented swelling and poor vascularization which was not efficient for good healing. Functional positions with orthosis were difficult according to swelling. We used NPWT for reducing swelling and optimizing tissue before coverage procedure. Skin graft was performed at day 30 and 35, and healing was achieved.

Subcutaneous calcium solutions lead to signs of inflammation and often severe swelling several days after extravasation. Significant risk of skin necrosis is observed and depends of concentration, volume, duration of infiltration of agent and increased in neonate population. There’s no consensus on management but recently several authors in the literature advocated early treatment with aspiration and washout techniques to dilute and remove the infused agent. If there is evidence of necrosis, debridement and coverage with skin graft or flap must be performed but can be impaired by the importance of swelling and local vascularization. NPWT can improve local conditions for good healing. Progressive clearing of tissue calcification occurred with no evidence at 6 months. Long-term scars remained with cosmetic and functional implications.

In conclusion, extravasation injuries are iatrogenic accidents. Prevention and early treatment are the best management. Calcic solutions can lead to severe tissue damage with skin necrosis and swelling which required surgery. NPWT can optimize this treatment.

Authors

Marie-Christine Plancq
Chu d' Amiens, Department of pediatric surgery, Amiens, France

Celine Klein
Chu d' Amiens, Department of pediatric surgery, Amiens, France

Francois Deroussen
Chu d' Amiens, Department of pediatric surgery, Amiens, France

Richard Gouron
Chu d' Amiens, Department of pediatric surgery, Amiens, France

Management of pediatric extravasation injuries with NPWT