von Heimburg D, Pallua N
Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, RWTH Aachen.
Chirurg. 1998 Dec;69(12):1378-82. doi: 10.1007/s001040050588.
Extravasation injuries can result in extensive soft-tissue defects. On the cellular level there are five different pathophysiological mechanisms. Early treatment (surgical removal of the extravasated material within 24 h) and late treatment (debridement and coverage) are different. Thirty-two patients who suffered a significant extravasation were treated surgically by the Department of Plastic Surgery between 1989 and 1997. In 8 patients, referred within the first 24 h, the extravasated material could be removed by saline flushout. None of these patients developed soft-tissue defects or skin necrosis. The other 24 patients were referred late (mean 19 days after the injury). Patients with defects of the dorsum of the hand or cubital fossa area who underwent debridement, temporary wound coverage and skin grafting (n = 11) presented complete healing 52 days after the referral. Defects of the same regions covered by a flap after debridement (n = 6) healed within 14 days. The healing time of defects of the forearm (n = 2) and dorsum of the foot (n = 5) was a mean of 15 days after skin grafting. Cytotoxic and osmotically active substances should be removed by saline flushout within 24 h. In defects of the dorsum of the hand and cubital fossa, early debridement and coverage with an adequate flap should be performed.
外渗性损伤可导致广泛的软组织缺损。在细胞水平上有五种不同的病理生理机制。早期治疗（在24小时内手术清除外渗物质）和晚期治疗（清创和覆盖）有所不同。1989年至1997年间，整形外科对32例发生严重外渗的患者进行了手术治疗。8例在最初24小时内转诊的患者，外渗物质可通过生理盐水冲洗清除。这些患者均未出现软组织缺损或皮肤坏死。另外24例患者转诊较晚（受伤后平均19天）。手部背部或肘窝区域有缺损且接受清创、临时伤口覆盖和皮肤移植的患者（n = 11），转诊后52天完全愈合。清创后用皮瓣覆盖相同区域的缺损患者（n = 6）在14天内愈合。前臂（n = 2）和足背（n = 5）缺损在皮肤移植后的平均愈合时间为15天。细胞毒性和具有渗透活性的物质应在24小时内通过生理盐水冲洗清除。对于手部背部和肘窝的缺损，应尽早进行清创并用合适的皮瓣覆盖。
