Doxorubicin
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Drug extravasation: case report A 66-year-old woman developed drug extravasation following treatment with doxorubicin for germinal centre B-cell type diffuse large cell B-cell non-Hodgkin lymphoma. The woman presented with swelling and erythema on the proximal wrist, dorsal surface of her right hand and thenar/hypothenar region. She had been receiving IV doxorubicin [Adriamycin], and presenting symptoms were due to doxorubicin extravasation. The extravasation time remained unknown. On presentation, the IV Venflon had been already flushed with sodium chloride solution [Saline]. The woman underwent subcutaneous washout procedure at >6h post-presentatin, which included small incisions on the affected site, drainage and flushing with sodium chloride solution. Thereafter, her wounds were bandaged and the affected right hand was held at elevated position. Concurrently, she was treated with dexrazoxane [Savene] for oncolytic detoxification. In the following days, the swelling disappeared, but she developed epidermolysis with intact hand functions. After 18 days of the injury, the necrosis of affected hand increased. Therefore, she underwent excision of the indurated region under unspecified general anaesthesia by applying a tourniquet at 280mm Hg, 25 days after the injury. She underwent dorsal fasciotomy of her intrinsic hand muscles, and all extensor tendons were spared even though the doxorubicin had eroded through the dorsal interossei and paratenons. Postoperatively, her wound was treated using a vacuum-assisted closing device. At 32 days after injury, a right-sided superficial circumflex iliac perforator (SCIAP) island flap was prepared and placed on the dorsal surface of the hand. Thereafter, she developed no further tissue necrosis. She underwent hand physiotherapy everyday for maintain normal blood flow and proper hand functioning. Meanwhile, her lymphoma was treated with rituximab due to harmful effects from doxorubicin on wound healing. The flap remained attached to the hand for 4 weeks which was then cleaved. The skin on the ulnar side of the flap became venous congested and was treated with lidocaine cream. Three days later, she developed wound infection of the flap and was treated with flucloxacillin for 4 days. During 2-month follow-up visit, she received hand physiotherapy and had infection of the flap. The affected hand became completely functional. de Jongh FW, et al. The consequences of delayed treatment in doxorubicin extravasation. European Journal of Plastic Surgery : 21 Jul 2020. Available from: URL: http:// 803508355 doi.org/10.1007/s00238-020-01715-y
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Reactions 17 Oct 2020 No. 1826
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