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Mutsago T, Kazzazi D, Ibrahim Y, Kazzazi F, Patel H, Pafitanis G. Phenytoin Induced Purple Glove Syndrome: An Effective Management Technique. Hosp Pharm 2024; 59:276-281. [PMID: 38764997 PMCID: PMC11097927 DOI: 10.1177/00185787231224064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Background: Purple glove syndrome (PGS) is a rare condition characterized by limb edema, discoloration, and pain associated with intravenous and oral phenytoin administration. The pathophysiology is poorly understood, and there is no established treatment. Simple cases have previously been managed with hyaluronidase subcutaneous injections, with more severe cases resulting in compartment syndrome, debridement, or even amputation. Methods/Results: In this case report, a 2-year-old boy with status epilepticus developed PGS after receiving intravenous phenytoin via a cannula on the dorsum of the right hand. The patient was successfully managed by locally infiltrating subcutaneous hyaluronidase diffusely to the affected area, titrating its dose to effect, rather than aiming to adhere to any specific dosing limitation. The child was reviewed daily by the Plastic Surgery team until being discharged, and focal lesions began to demarcate after 48 hours, with epidermal loss but no deeper trauma. The epidermis peeled within one month, with healthy underlying skin found underlying when followed up in clinic. Conclusions: This case illustrates that subcutaneous administration of hyaluronidase and titrating to effect provides an effective and safe treatment for treating distal cases of early PGS in children.
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Azoury SC, Matros E. Top 25 Medications the Plastic and Reconstructive Surgery Trainee Should Know for an Emergency Medicine Department Consult. Plast Reconstr Surg 2024; 153:474e-489e. [PMID: 37141488 DOI: 10.1097/prs.0000000000010609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
SUMMARY Plastic surgery trainees are often called to render care in the emergency department (eg, for established patients, trauma, burns). Broad-based knowledge in pharmacotherapeutics during these encounters is critical. This includes an understanding of pain medications, anxiolytics, local anesthetics, antibiotics, anticoagulants, antidotes, and more to ensure optimal patient care. The purpose of this report is to describe 25 frequently used and other important medications that plastic surgery trainees should know for an adult emergency department encounter.
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Affiliation(s)
- Saïd C Azoury
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania
| | - Evan Matros
- Division of Plastic Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center
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Abstract
Drug reactions resulting from chemotherapy agents are common and frequently affect the skin. Although often benign, a select few of these cutaneous reactions may necessitate immediate changes to the antineoplastic regimens. Given the diversity of chemotherapeutic skin reactions and their complex implications on patient management, an organized conceptual schema is imperative for proper patient care. We evaluate a number of commonly seen chemotherapy-induced skin toxicities organized by pathogenic mechanism and drug class, providing a framework for the identification and categorization of adverse events to prevent unrecognition. Groupings of these reactions include direct cytotoxicity and/or drug accumulation, immunologic hypersensitivity, and aberrant molecular signaling.
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Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA.
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Maly C, Fan KL, Rogers GF, Mitchell B, Amling J, Johnson K, Welch L, Oh AK, Chao JW. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1743. [PMID: 29876181 PMCID: PMC5977944 DOI: 10.1097/gox.0000000000001743] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/07/2018] [Indexed: 02/07/2023]
Abstract
Intravenous therapy is a common practice among many specialties. Intravenous therapy extravasation is a potential complication to such therapy. Hospitals without a dedicated wound care team trained in these interventions will often default to plastic surgical consultation, making an understanding of available interventions essential to the initial evaluation and management of these injuries. The goal of this article was to provide plastic surgeons and health care providers with a general overview of the acute management of intravenous infiltration and extravasation injuries. Though the decision for surgical versus nonsurgical management is often a clear one for plastic surgeons, local interventions, and therapies are often indicated and under-utilized in the immediate postinfiltration period. Thorough knowledge of these interventions should be a basic requirement in the armamentarium of plastic surgery consultants.
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Affiliation(s)
- Connor Maly
- Georgetown University School of Medicine, Washington, D.C
| | - Kenneth L Fan
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, D.C
| | - Gary F Rogers
- Division of Plastic Surgery, Children's National Health System, Washington, D.C
| | | | - June Amling
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, D.C.,Division of Nursing, Children's National Health System, Washington, D.C
| | - Kara Johnson
- Division of Nursing, Children's National Health System, Washington, D.C
| | - Laura Welch
- Division of Nursing, Children's National Health System, Washington, D.C
| | - Albert K Oh
- Division of Plastic Surgery, Children's National Health System, Washington, D.C
| | - Jerry W Chao
- Division of Plastic Surgery, Children's National Health System, Washington, D.C.,Division of Plastic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, D.C
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Gil JA, Shah KN, Suarez L, Weiss APC. Upper-Extremity Extravasation: Evaluation, Management, and Prevention. JBJS Rev 2017; 5:e6. [PMID: 28796697 DOI: 10.2106/jbjs.rvw.16.00102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joseph A Gil
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kalpit N Shah
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Luis Suarez
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Arnold-Peter C Weiss
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Ghanem AM, Mansour A, Exton R, Powell J, Mashhadi S, Bulstrode N, Smith G. Childhood extravasation injuries: Improved outcome following the introduction of hospital-wide guidelines. J Plast Reconstr Aesthet Surg 2015; 68:505-18. [DOI: 10.1016/j.bjps.2014.12.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/13/2014] [Indexed: 11/26/2022]
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Abstract
Extravasation injuries are common emergencies in clinical practice. If they are not recognized and treated promptly, they can lead to deleterious functional and cosmetic outcomes. There is a vast range of agents involved in these injuries and marked paucity of evidence to support their specific management. Following an extensive literature review, we outline management principles for clinicians involved in the care of patients with extravasation injuries. Key parameters in deciding appropriate management plans include the volume/toxicity of the agent, the necrosis interval of the injury, patient-related factors, as well as the facilities and expertise available in the setting of individual cases of extravasation.
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Affiliation(s)
- I Goutos
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Headington, Oxford, UK
| | - L K Cogswell
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Headington, Oxford, UK
| | - H Giele
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Headington, Oxford, UK
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Hanrahan K. Hyaluronidase for treatment of intravenous extravasations: implementation of an evidence-based guideline in a pediatric population. J SPEC PEDIATR NURS 2013; 18:253-62. [PMID: 23822849 DOI: 10.1111/jspn.12035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 03/04/2013] [Accepted: 03/15/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE To describe the implementation and evaluation of an evidence-based guideline, Hyaluronidase for Treatment of IV Extravasations, in a pediatric population. CONCLUSIONS Evidence of hyaluronidase efficacy suggests that timely administration will decrease the severity of tissue damage caused by extravasations, and result in cost savings. Implementation of this guideline increased user knowledge, incident reporting, and initiation of treatment, and decreased the average time to treatment administration. PRACTICE IMPLICATIONS Implementation strategies facilitate integration and sustained use of evidence-based treatments in clinical practice. Processes that promote evidence-based treatment are expected to improve outcomes and are therefore an important component of evaluation.
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Affiliation(s)
- Kirsten Hanrahan
- University of Iowa College of Nursing, University of Iowa Children's Hospital, Iowa City, Iowa, USA.
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Gonzalez T. Chemotherapy Extravasations: Prevention, Identification, Management, and Documentation. Clin J Oncol Nurs 2013; 17:61-6. [DOI: 10.1188/13.cjon.61-66] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Boschi R, Rostagno E. Extravasation of antineoplastic agents: prevention and treatments. Pediatr Rep 2012; 4:e28. [PMID: 25396033 PMCID: PMC4227315 DOI: 10.4081/pr.2012.e28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/02/2011] [Indexed: 11/22/2022] Open
Abstract
The extravasation of antineoplastic agents is an unwanted and distressing situation that can easily occur. It may cause severe and irreversible local injuries. Left untreated, vesicant chemotherapy extravasation can potentially cause tissue necrosis, functional impairment and permanent disfigurement. This article provides a review of current literature regarding recommendations on the prevention and treatment of extravasation of antineoplastic agents.
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Abstract
OBJECTIVE To present a clinical update on the prevention, detection, and evidence-based management of vesicant chemotherapy extravasations. DATA SOURCES Journal articles, published and unpublished case reports, personal experience. CONCLUSION In the 4 years that have elapsed since the publication of the original article, much more is known about vesicant chemotherapy extravasation, and effective evidence-based treatments now are available. The antidotes sodium thiosulfate for mechlorethamine extravasations and hyaluronidase for plant alkaloid extravasations are recommended by the manufacturers of these vesicants and cited in nursing guidelines. The anthracycline extravasation treatment dexrazoxane for injection, the first and only extravasation treatment with proven effectiveness, is now available as Totect (dexrazoxane; TopoTarget USA, Rockaway, NJ, USA) in the US and Savene (SpePharm, Amsterdam, The Netherlands) in Europe. IMPLICATIONS FOR NURSING PRACTICE Nurses who administer vesicant chemotherapy agents need to be aware of the most current evidence (or lack of evidence) for various types of extravasation treatment. Well-informed nurses are patient advocates and instrumental in detecting, managing, and documenting extravasations. Most importantly, nurses play a key role in preventing vesicant chemotherapy extravasations.
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Subcutaneous wash-out procedure (SWOP) for the treatment of chemotherapeutic extravasations. J Plast Reconstr Aesthet Surg 2011; 64:240-7. [DOI: 10.1016/j.bjps.2010.04.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 04/21/2010] [Accepted: 04/23/2010] [Indexed: 11/20/2022]
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