Extensive Cutaneous Necrosis of Hand and Forearm Due to Extravasation of Norepinephrine Requiring Fascia Transplantation and Anterolateral Thigh Flap -A Case Report

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  • KOGA Haruka
    Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University
  • MORI Hiroki
    Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University
  • HOMMA Tsutomu
    Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University
  • KATO Sayuri
    Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University
  • ISHIDA Naoya
    Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University
  • TANAKA Kentaro
    Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University
  • YAGI Masayuki
    Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University
  • MORISHITA Koji
    Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University

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Other Title
  • ノルアドレナリンの血管外漏出による前腕以遠の広範囲皮膚軟部組織壊死に対して筋膜移植，皮弁再建を要した1例

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<p>  Norepinephrine is recommended to be administered via the central venous route. However, in the emergency field, norepinephrine is often given from the peripheral vascular route. The present case was a 59-year-old man with a history of chronic renal failure who had a shunt on his left forearm. Norepinephrine was injected through the peripheral vascular route of the right forearm because pyogenic spondylitis caused septic shock. On the 18th day after extravasation of norepinephrine, he was referred to our department. At the time of surgery, all extensor tendons were necrotic, and the joint capsule of his wrist was necrotic. The joint capsule was reconstructed using the tensor fascia lata, and the soft tissue was reconstructed using anterolateral thigh flap. Since there was no flexor tendon injury, certain activities of daily living were possible with the use of a wrist extension orthotic device. In this case, the antagonist phentolamine was not administered, leading to widespread soft tissue necrosis. Extravasation of drugs is an iatrogenic disorder and requires efforts to reduce the extent of damage as much as possible. Norepinephrine, which is the most frequently used vasoconstrictor, should be documented and all staff involved should be informed, including treatment with antagonists.</p>

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