Trauma & Orthopaedic Surgery, Whittington Hospital NHS Trust, London, UK.
Plastic and Reconstructive Surgery, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK.
BMJ Open. 2020 Aug 6;10(8):e034950. doi: 10.1136/bmjopen-2019-034950.
This systematic review aims to assess the quality of literature supporting surgical interventions for paediatric extravasation injury and to determine whether there is sufficient evidence to support invasive techniques in children.
We performed a systematic review by searching Ovid MEDLINE and EMBASE as well as AMED, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and clinicaltrials.gov from inception to February 2019. Studies other than case reports were eligible for inclusion if the population was younger than 18 years old, if there was a surgical intervention aimed at treating extravasation injury and if they reported on outcomes. Study quality was graded according to the National Institutes of Health study quality assessment tools.
26 studies involving 728 children were included-one before-and-after study and 25 case series. Extravasation injuries were mainly confined to skin and subcutaneous tissues but severe complications were also encountered, including amputation (one toe and one below elbow). Of the surgical treatments described, the technique of multiple puncture wounds and instillation of saline and/or hyaluronidase was the most commonly used. However, there were no studies in which its effectiveness was tested against another treatment or a control and details of functional and aesthetic outcomes were generally lacking.
Surgical management is commonly reported in the literature in cases where there is significant soft tissue injury but as there are no comparative studies, it is unclear whether this is optimal. Further observational and experimental research evaluating extravasation injuries, including a centralised extravasation register using a universal grading scheme and core outcome set with adequate follow-up, are required to provide evidence to guide clinician decision-making.
本系统评价旨在评估支持小儿外渗损伤手术干预的文献质量，并确定是否有足够的证据支持儿童采用有创技术。
我们对 Ovid MEDLINE 和 EMBASE 以及 AMED、CINAHL、Cochrane 对照试验中心注册库、Cochrane 系统评价数据库和 clinicaltrials.gov 进行了系统检索，检索时间从建库至 2019 年 2 月。如果研究人群年龄小于 18 岁，存在旨在治疗外渗损伤的手术干预措施，并报告了结局，则将除病例报告以外的研究纳入。根据美国国立卫生研究院研究质量评估工具对研究质量进行分级。
共纳入 26 项研究，涉及 728 例儿童，其中 1 项为前后对照研究，25 项为病例系列研究。外渗损伤主要局限于皮肤和皮下组织，但也发生了严重并发症，包括截肢（1 例脚趾和 1 例肘下）。所描述的手术治疗中，最常使用的技术是多处穿刺伤和生理盐水/或透明质酸酶灌洗。然而，没有研究将其有效性与另一种治疗方法或对照进行比较，且功能和美学结局的详细信息通常缺乏。
尽管没有比较研究，但由于大量文献报告了存在明显软组织损伤的情况下采用了外科治疗，因此外科治疗在文献中很常见，但不清楚这种治疗方法是否最佳。需要进一步开展观察性和实验性研究，以评估外渗损伤，包括使用通用分级方案和具有充分随访的核心结局集的集中外渗登记处，以提供证据来指导临床医生的决策。
