Mr Leonardo Cordova1, Dr Sarah Lonie1, Ms Rebecca Schrale1, Mr Andrew Castley1
1Royal Hobart Hospital
Extravasation burn injuries, particularly in neonates, are often referred to plastic surgery teams for advice and management. Depending on type and quantity of fluid extravasated they can have variable severity. There are currently no treatment guidelines on time to referral and initial treatment at our hospital and this can often vary. This retrospective review of extravasation burns at the Royal Hobart Hospital (RHH), Tasmania from 2008-2016 aimed to assess frequency, cause and sequelae of extravasation burn injuries.
We reviewed all extravasation burn patients whose data is registered with the Burns Registry of Australia and New Zealand and patients identified from the RHH coding on complications. Factors contributing to and which may worsen these injuries severity (fluid, quantity, time to plastics referral, first aid) were identified. In terms of management, we reviewed dressings used, injuries which required surgical intervention, time to healing and scarring.
11 cases were identified of which 10 were neonatal cases. Time of referral post-injury to the plastic surgery team was often a number of days. Of all the substances extravasated, 27% were total parenteral nutrition, 27% maintenance fluid (dextrose and saline) and 46% others. Three cases required operative intervention.
Our case series highlights the importance of increased awareness of the potential sequelae of extravasation injuries. As a result of this audit, we plan to create guidelines on treatment of extravasation burn injuries, to optimise management, improve patient outcomes and ensure timely, early referral to the plastic surgery team.
Sarah is a current plastic surgery registrar at Peter MacCallum Hospital Melbourne. In 2016, she worked at Royal Hobart Hospital as registrar in burns and plastic surgery.