Mas Virginie, Simon Anne Laure, Presedo Ana, Mallet Cindy, Ilharreborde Brice, Jehanno Pascal
Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France.
Department of Orthopaedic Surgery and Hand Emergencies, Hôpital Privé des Peupliers, Paris, France.
J Child Orthop. 2020 Jun 1;14(3):230-235. doi: 10.1302/1863-2548.14.200020.
Extravasation of cytotoxic vesicant drugs is a surgical emergency (within six hours) since this incident can lead to severe skin and soft-tissue damage. Outcomes after the saline washout procedure have been extensively described in adults, but rarely in children. The aim of this study was to evaluate the outcome of early saline washout procedure for upper limb cytotoxic drug extravasation in children.
All consecutive children with vesicant drug extravasation were retrospectively reviewed. The saline washout procedure was performed. Cosmetic aspect, residual pain and range of movement were analyzed as well as time to surgery and chemotherapy resumption at last follow-up.
Between 2014 and 2018, 13 cytotoxic vesicant drug extravasations occurred (mean age 8 years (sem 5)), including 11 treated by the saline washout procedure. At mean follow-up of 11 months (sem 7), the patients had no or low pain and ranges of movement were fully conserved. Two patients (one within the six hours' delay) had soft-tissue necrosis leading to extensive reconstructive surgery.
The saline washout procedure is safe and easy and significantly reduces the incidence of extensive skin damage. Early referral to a specialized department is essential. However, the key parameter remains prevention by educating medical staff and nurses about these injuries and by training them for early and urgent management.
IV.
细胞毒性发泡剂药物外渗是一种外科急症（6小时内），因为这一事件可导致严重的皮肤和软组织损伤。生理盐水冲洗 procedure 的结果在成人中已有广泛描述，但在儿童中却很少见。本研究的目的是评估儿童上肢细胞毒性药物外渗早期生理盐水冲洗 procedure 的结果。
对所有连续性发泡剂药物外渗患儿进行回顾性研究。实施生理盐水冲洗 procedure。分析了美容效果、残留疼痛和活动范围，以及最后一次随访时的手术时间和化疗恢复时间。
2014年至2018年期间，发生了13例细胞毒性发泡剂药物外渗（平均年龄8岁（标准误5）），其中11例接受了生理盐水冲洗 procedure。平均随访11个月（标准误7）时，患者无疼痛或疼痛轻微，活动范围完全保留。2例患者（1例在6小时延迟内）发生软组织坏死，需要进行广泛的重建手术。
生理盐水冲洗 procedure 安全简便，可显著降低广泛皮肤损伤的发生率。尽早转诊至专科至关重要。然而，关键参数仍然是通过对医护人员进行这些损伤的教育以及对他们进行早期和紧急处理的培训来预防。
IV级。
