Minimal surgical debridement for the treatment of chemotherapeutic agent-induced skin extravasations.

A rat model was employed to determine the efficacy of early minimal debridement in decreasing the size of chemotherapeutic agent-induced skin ulcers. After receiving bilateral flank injections of doxorubicin in a concentration comparable to that received by humans, the right injection site underwent minimal debridement 1, 24, or 72 hours after the injection. The left side of each animal was not operated upon and served as a control. Three subgroups of the 1-, 24-, and 72-hour debridement groups were treated as previously described, except that any residual necrotic tissue was debrided 1 week after the original debridement. All minimal debridement and redebridement groups produced significant decreases in ulcer size compared to controls. Comparing minimal debridement and redebridement groups to controls, it was found that surgery produced reductions in the number of persistent ulcers in all groups. Minimal debridement followed by redebridement was significantly more effective than minimal debridement alone in decreasing ulcer size acutely. One case is presented in which an extravasation of dactinomycin was treated by early minimal debridement. The patient had an uncomplicated postoperative course, and at follow-up 21 months after surgery had excellent functional and cosmetic results. Based upon animal studies and human experience, early surgical debridement appears to be a promising new method for the treatment of clinically significant vesicant extravasations in humans.