Ekstravazasyon sonrası oluşan cilt nekrozunun hidrocerrahi (Versajet) sistemi ile debridmanı: Dokuz yenidoğandaki deneyimlerimiz

Öz

Amaç: Çalışmamızın amacı, kalsiyum glukonat ekstravazasyonuna bağlı cilt nekrozlarında Versajet hidrocerrahi sistemi ile uygulanan debridmanın sonuçlarını değerlendirmekti. Çalışma planı: Kalsiyum glukonat ekstravazasyonu olan 9 yenidoğan (ortalama yaş: 26 gün; dağılım: 1 gün–3 ay) çalışmaya alındı. Yaralanma bölgesi 3 hastada ayak, 5 hastada el ve el bileği, bir hastada ise saçlı deri idi. Tüm hastalarda cilt nekrozları genel anestezi altında Versajet hidrocerrahi sistemi ile alttaki dermis tabakasına zarar vermeden debride edildi. Bulgular: Tüm yaralar ortalama 14 gün içinde tam olarak epitelize olup spontan iyileşti. Hiçbir hastada ikinci bir debridmana gerek duyulmadı. En az 1 yıllık takip süresi sonunda minimal skar gelişimi olduğu hiçbir hastada hipertrofik skar dokusu gelişmediği gözlendi. Çıkarımlar: Versajet hidrocerrahi sistemi kalsiyum glukona ekstravazasyonuna bağlı cilt nekrozlarının debridmanında etkili bir yöntem olarak gözükmektedir.

Anahtar Kelimeler

• Versajet hidrocerrahi sistemi; ektravazasyon; Ca glukonat; infant.

Versajet hydrosurgery system in the debridement of skin necrosis after Ca gluconate extravasation: report of 9 infantile cases

Abstract

Objective: The aim of the study was to evaluate the results of debridement with Versajet hydrosurgery system in patients with skin necrosis after ca gluconate extravasation.
Methods: We evaluated nine infants (mean age: 26 days; range: 1 day to 3 months) with calcium gluconate extravasation injury. Site of injury was the foot in 3 cases, the hand and wrist in 5 and the scalp in one. In all patients the skin necrosis was debrided with Versajet hydrosurgery system under general anesthesia without damaging the dermis layer.
Results: Following debridement all wounds healed spontaneously by re–epithelization and the mean time of full epithelization was fourteen days. No patient required a second debridement. At a minimum follow–up of 1 year minimal scar formation was noted and there was no hypertrophic scar.
Conclusion: Versajet hydrosurgery system appears to be effective in the debridement of skin necrosis due to ca gluconate extravasation in pediatric population.

Keywords

• Versaje hydrosurgery system
• extravasation
• Ca gluconate
• infant

References

1. Murphy PM, Gault DT. Treatment of extravasation injury. Anaesthesia 1990;45:600.
2. Hannon MG, Lee SK. Extravasation injuries. J Hand Surg Am 2011;36:2060-6.
3. Namazi H. Extravasation injuries: a practice pearl. [Letter to the Editor] J Hand Surg Am 2012;37:861.
4. Heitmann C, Durmus C, Ingianni G. Surgical management after doxorubicin and epirubicin extravasation. J Hand Surg Br 1998;23:666-8.
5. Wong FC, Kim, EE, Sparks, R, Wong W-H, Yang DJ, Podoloff DA. Three sphere dosimetry models (0.4 cc, 2cc and 10cc) of 12 commonly available radionuclides for locoregional therapy or extravasation. J Nucl Med 2001;42(5 Suppl):28.
6. Dionyssiou D, Chantes A, Gravvanis A, Demiri E. The wash-out technique in the management of delayed presentations of extravasation injuries. J Hand Surg Eur Vol 2011;36:66-9.
7. Domínguez-Fernández I, Goíriz R, Pérez-Gala S, Fraga J, Fernández-Herrera J. Calcinosis cutis following extravasation of calcium salts. J Eur Acad Dermatol Venereol 2008;22:505-6.
8. Cedidi C, Hierner R, Berger A. Plastic surgical management in tissue extravasation of cytotoxic agents in the upper extremity. Eur J Med Res 2001;6:309-14.

9. Fraccalvieri M, Serra R, Ruka E, Zingarelli E, Antoniotti U, Robbiano F, et al. Surgical debridement with VERSAJET: an analysis of bacteria load of the wound bed preand post-treatment and skin graft taken. A preliminary pilot study. Int Wound J 2011;8:155-61.
10. Soong M, Schmidt S. Acute contaminated open forearm fractures treated with VersaJet Hydrosurgical Débridement. J Orthop Trauma 2010;24:66-8.
11. Dillon CK, Lloyd MS, Dzeiwulski P. Accurate debridement of toxic epidermal necrolysis using Versajet. Burns 2010;36:581-4.
12. Kimble RM, Mott J, Joethy J. Versajet hydrosurgery system for the debridement of paediatric burns. Burns 2008;34:297-9.
13. Jeffery SL. Versajet hydrosurgery in burns wound debridement: a preliminary experience by Gravante G, Esposito G, Delogu D, Montone A. Burns 33;207:401-2. Burns 2007;33:800.
14. Millam DA. Managing complications of i.v. therapy (continuing education credit). Nursing 1988;18:34-43.
15. Lin CY, Hsieh KC, Yeh MC, Sheen-Chen SM, Chou FF. Skin necrosis after intravenous calcium chloride administration as a complication of parathyroidectomy for secondary hyperparathyroidism: report of four cases. Surg Today 2007;37:778-81.
16. Lehnhardt M, Vu P, Kuhnen C, Steinstraesser L, Muehlberger T, Druecke D, et al. Serious complications of injections-retrospective analysis of incidences, complicationmanagement, prophylaxis and economic aspects. [Article in German] Zentralbl Chir 2005;130:162-9. [Abstract]
17. Schummer W, Schummer C, Müller A, Karzai W. Extravasation: a rare complication of central venous cannulation? Case report of an imminent erosion of the common carotid artery. [Article in German] Anaesthesist 2003;52:711[Abstract]
18. Kumar RJ, Pegg SP, Kimble RM. Management of extravasation injuries. ANZ J Surg 2001;71:285-9.