ABSTRACT
In addition to their therapeutic effects on malignant cells, cytotoxic agents have
the potential of causing destruction of healthy, normal cells. Extravasation of the
drug can produce extensive necrosis of the skin and subcutaneous tissue. Management
of these extravasational effects differs from one centre to another and prevention
is usually strongly emphasized. We analyzed our management of 12 patients referred
to us over five years with extravasation of cytotoxic drugs and reviewed the literature
for different approaches with regard to prophylaxis and management of extravasational
effects. Materials and Methods: This study was done in the department of plastic
surgery of a medical college. Five years of retrospective data were studied of patients
referred to our department with extravasation of cytotoxic drugs. Results: We managed
12 cases referred to our department with extravasation of cytotoxic drugs. Mitomycin
C was used in seven cases (58.33%), vincristine in two cases (16.66%), 5-Florouracil
in another two cases while doxorubicin was responsible for extravasational side effects
in one case (8.33%). The size of necrosis ranged from 3.75 cm 2 to 25 cm 2 with average size of 9.6 cm 2 . In terms of the area involved, the dorsum of the hand was involved in five cases
(41.66%), the wrist in another five cases (41.66%), and the cubital fossa in the remaining
two cases (16.66%). All cases were treated with daily debridement of necrotic tissue,
saline dressing, and split skin grafting. Conclusion: Extravasation of cytotoxic
drugs further increases the suffering of cancer patients. This catastrophe can only
be avoided by vigilance and immediate application of antidotes. Once the local toxicity
of the drugs takes effect, morbidity is unavoidable
KEY WORDS
Cytotoxic - drugs - extravasation - prevention - side effects
