• Extravasation
• antidotes
• antineoplastics
• irritant
• vesicant

• Humans
• Antidotes/therapeutic use
• Antineoplastic Agents/administration & dosage
• Antineoplastic Agents/adverse effects
• Extravasation of Diagnostic and Therapeutic Materials
• Infusions, Intravenous

• Pinch-off syndrome
• central venous access
• chemotherapy
• extravasation
• wash-out

Intravenous therapy is a common practice among many specialties. Intravenous therapy extravasation is a potential complication to such therapy. Hospitals without a dedicated wound care team trained in these interventions will often default to plastic surgical consultation, making an understanding of available interventions essential to the initial evaluation and management of these injuries. The goal of this article was to provide plastic surgeons and health care providers with a general overview of the acute management of intravenous infiltration and extravasation injuries. Though the decision for surgical versus nonsurgical management is often a clear one for plastic surgeons, local interventions, and therapies are often indicated and under-utilized in the immediate postinfiltration period. Thorough knowledge of these interventions should be a basic requirement in the armamentarium of plastic surgery consultants.

Anthracycline extravasation is a feared complication of intravenous (i.v.) chemotherapy due to the tissue toxicity of this group of drugs. We describe a 54-year-old woman with history of stage IIIa breast cancer, receiving adjuvant chemotherapy consisting of doxorubicin and cyclophosphamide. The chemotherapy was administered through a Poweport^® device, the position of which was confirmed with fluoroscopy and function confirmed by flushing the line. Urgent intervention was required as patient was symptomatic and experienced severe right-sided pleuritic chest pain. Radiology also confirmed the extravasation of doxorubicin into the pleural space. Surgical washout of the pleural space and 3 days therapy with i.v. dexrazoxane were carried out to prevent tissue damage and long-term sequelae. Use of dexrazoxane should always be considered following intra-pleural extravasation because of its potential efficacy and reasonable tolerability. However, the best approach to extravasation injury is prevention by systematic implementation of careful, standardized, evidence-based administration techniques.

Chemotherapy extravasation remains an accidental complication of chemotherapy administration and may result in serious damage to patients. We review in this article the clinical aspects of chemotherapy extravasation and latest advances in definitions, classification, prevention, management and guidelines. We review the grading of extravasation and tissue damage according to various chemotherapeutic drugs and present an update on treatment and new antidotes including dexrazoxane for anthracyclines extravasation. We highlight the importance of education and training of the oncology team for prevention and prompt pharmacological and non-pharmacological management and stress the availability of new antidotes like dexrazoxane wherever anthracyclines are being infused.

• Chemotherapy
• Extravasation
• Vesicant
• Tissue damage
• Dimethyl sulfoxide
• Dexrazoxane
• Antidote
• Hyaluronidase

• Aneuploidy
• Birth defects
• Dexrazoxane
• Doxorubicin
• Oxidative DNA damage
• Secondary malignancies

• Aneuploidy
• Animals
• Antibiotics, Antineoplastic/administration & dosage
• Antibiotics, Antineoplastic/toxicity
• Antineoplastic Agents/administration & dosage
• Antineoplastic Agents/pharmacology
• Bone Marrow Cells/cytology
• Bone Marrow Cells/drug effects
• DNA Damage/drug effects
• Dexrazoxane/administration & dosage
• Dexrazoxane/pharmacology
• Dose-Response Relationship, Drug
• Doxorubicin/administration & dosage
• Doxorubicin/toxicity
• In Situ Hybridization, Fluorescence/methods
• Male
• Mice
• Micronucleus Tests
• Spermatozoa/cytology
• Spermatozoa/drug effects