Chirurgische Behandlung von Paravasaten

 

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Zusammenfassung

Hintergrund: Paravasate gehören zu den häufigsten iatrogenen Verletzungen. Ziel dieser Studie war es, die operative Versorgung von Patienten mit Paravasaten zu untersuchen und Rückschlüsse für die zukünftige Versorgung zu ziehen. Material und Methoden: Zwischen 1999 und 2009 wurden 24 Patienten mit Nekrosen nach Paravasaten in unserer Klinik behandelt. Die Fälle wurden retrospektiv analysiert. Die Nekrose verursachenden Substanzen und die Lokalisation wurden mit der Anzahl der Eingriffe, Komplexität der Rekonstruktion ins Verhältnis gesetzt. Ergebnisse: Chemotherapeutika (83 %, n = 20), Kontrastmittel (8 %, n = 2), Antibiotika (4 %, n = 1) und Insulin (4 %, n = 1) waren die auslösenden Noxen. Zu 70 % war die obere Extremität, zu 30 % der Thorax betroffen. In 38 % kam es bei liegendem Port zum Paravasat. 2 ± 1,5 Operationen waren zur vollständigen Sanierung notwendig. Ein Patient verstarb an einer Sepsis auf dem Boden des infizierten Nekroseareals, der andere postoperativ an Rechtsherzversagen bei pulmonaler Vorschädigung. Schlussfolgerung: Ein Großteil der Paravasate lässt sich konservativ therapieren. Liegt ein toxisches Paravasat vor oder droht aufgrund des Gewebedrucks eine Minderperfusion, ist eine sofortige chirurgische Sanierung erforderlich, um eine Zerstörung tieferer Gewebeschichten zu verhindern. 

Abstract

Objective: Extravasations account for most iatrogenic injuries. The aim of the study was to analyse the results of surgery in patients with extravasations and to draw conclusions for future treatment. Materials and Methods: 24 patients with soft-tissue defects after extravasations were treated between 1999 and 2009 in our hospital. The cases were analysed retrospectively. We looked at the drugs causing tissue necrosis and the localisation in relation to the number of interventions and reconstruction complexity. Results: In 83 % (n = 20) of cases tissue necrosis was caused by chemotherapeutic agents, in 8 % (n = 2) by contrast mediums and in 4 % (n = 1) by antibiotics and insulin. 70 % of the cases involved the upper extremity, in 30 % the thoracic wall was affected. 38 % of the extravasations occurred over venous access ports. In mean 2 ± 1.5 interventions were necessary for defect coverage. Two patients died as a direct result of the extravasations, one due to sepsis originating from an infected necrosis area and one due to right-heart failure with prior pulmonary damage. Conclusion: Most extravasations can be treated without surgery. In cases of toxic extravasations or pressure-caused ischaemia rapid surgical intervention is necessary to prevent the necrosis progressing to deeper tissue layers. 

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