Abstract:
Background: Extravasation of intravenous agents can lead to severe tissue injury, including necrosis and compartment syndrome, sometimes necessitating complex surgical intervention. Identifying factors that predict poor outcomes is crucial for guiding management. This study aimed to determine predictors of severe complications in patients with extravasation injuries referred for plastic surgery consultation.
Methods: We conducted a retrospective, single-center analysis of 37 patients who required non-conservative management for extravasation injuries between 2014 and 2024. The primary outcome was the development of a any complication that requires surgical treatment like skin necrosis or compartment syndrome. A Bayesian logistic regression model was employed to identify predictive factors, including the use of a subcutaneous wash-out procedure, catheter type, and agent type (vesicant vs. irritant vs. not harmful).
Results: The subcutaneous wash-out procedure was strongly associated with a reduced likelihood of severe complications. All other independent variables like days from incident to referral to plastic surgery, Volume administered and type of extravasated agent were not significant.
Conclusion: In this cohort of severe extravasation injuries requiring surgical consultation, the use of subcutaneous wash-out was associated with fewer severe complications accountable to its protective effect as well as correct patient selection as subcutaneous wash-out is not suitable for the treatment of necrosis or infection.
Reference:Milewski MR, Tamulevicius M, Enechukwu AOM, Bucher F, Kloss FJ, Schlottmann F, Dietz LJ, Franke N, Barros Navarro LA, Lorbeer L, Vogt PM. “Extravasation injuries requiring plastic surgery – a retrospective single center study”. JPRAS Open. 2026 Feb 8;50:421-436. doi: 10.1016/j.jpra.2026.02.003. PMID: 42326048; PMCID: PMC13276155.