Recall phenomenon or severe skin and muscle necrosis following Adriamycin extravasation in the hand.

A 56-year-old male, following pneumonectomy for oat cell carcinoma, was receiving Adriamycin intravenously. Early in his treatment schedule, the intravenous Adriamycin was alleged to have infiltrated, and was promptly stopped. However, treatment was continued through the veins of the other arm at three week intervals. The patient developed an extensive slough of the dorsum of the hand and forearm, including the extensor tendons and muscle, over a seven week period from the initial extravasation. Numerous debridements and skin grafting procedures were required to salvage the hand. It is suggested that the continued Adriamycin treatments had an additive effect in the already devitalized tissue, resulting in recall phenomenon, which further aggravated and enhanced the extent of necrosis. Ameliorative efforts to treat the extravasation in experimental and clinical settings have been ineffective. Care in the intravenous drug administration and dilution of Adriamycin are the best means of preventing the sequela of Adriamycin extravasation.