Childhood extravasation injuries: Improved outcome following the introduction of hospital-wide guidelines. Issue 4 (April 2015)

• Record Type: Journal Article
• Authors: Ghanem, Ali M.; Mansour, Abdulrab; Exton, Rebecca; Powell, Jonathan; Mashhadi, Syed; Bulstrode, Neil; Smith, Gillian
• Is Part Of: Journal of plastic, reconstructive & aesthetic surgery. Volume 68:Issue 4(2015:Apr.)
• Page Start: 505
• Page End: 518
• Publication Date: 2015-04
• Subjects: Surgery, Plastic -- Great Britain -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Great Britain -- Periodicals; 617.9505
• DOI: 10.1016/j.bjps.2014.12.029
• Languages: English
• ISSNs: 1748-6815

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Summary</title> <sec> <title id="sectitle0015">Introduction</title> <p id="abspara0010">Extravasation is an iatrogenic injury that may produce soft tissue necrosis requiring surgical reconstruction (Rose et al., 2008) and (Goon et al., 2006).<xref id="crosref0055" rid="bib1"><sup>1</sup></xref><sup>, 2</sup> Previous review of extravasation injuries within our hospital showed that early referral to plastic surgeons and washout of high-risk cases lead to favourable outcome in 86% of patients (Gault, 1993).<sup>3</sup> Hospital-wide guidelines were introduced in 2005. This paper closes the audit loop by evaluating extravasation injuries outcome following the introduction of these guidelines.</p> </sec> <sec> <title id="sectitle0020">Methods</title> <p id="abspara0015">All patients referred to the plastic surgery department for extravasation injuries between October 2008 and October 2009 were reviewed. A favourable outcome was defined as resolution without tissue loss requiring surgical reconstruction. Patients were excluded if they sustained the extravasation in other institution.</p> </sec> <sec> <title id="sectitle0025">Results</title> <p id="abspara0020">A total of 82 extravasation injuries in 78 patients were reviewed during the audit period. Mean age was 3.2 years (Median 0.2 years, Minimum 0 day, and maximum 16.7 years). The injuries were more frequent on the left half of the body (52%) and involving the upper limbs (59%). Mean time to referral was 8 h, with 60% of patients referred within 6 h of the injury, 30% in 6–12 h, and 10% referred after more than 12 h 26% of the injuries required washout treatment - the rest was treated conservatively. Tissue necrosis occurred in 3 cases (4%) but required no surgical intervention due to the small area affected.</p> </sec> <sec> <title id="sectitle0030">Conclusion</title> <p id="abspara0025">Our audit showed an improved outcome of extravasation injury following introduction of hospital-wide guidelines of early referral to specialist team and washout of high-risk cases.</p> </sec> </abstract>