Portal de Periódicos da CAPES

The Use of Hyalomatrix PA in the Treatment of Extravasation Affecting Premature Neonates

2011; Lippincott Williams & Wilkins; Volume: 129; Issue: 1 Linguagem: Inglês

10.1097/prs.0b013e3182365e16

1529-4242

Maria Giuseppina Onesti, Sara Carella, Michele Maruccia, Mariangela Ciotti, Nicolò Scuderi,

Traumatic Ocular and Foreign Body Injuries

Sir:FigureExtravasation occurs when fluid comes out of the vessel. In neonatal intensive care units, extravasation is one of the most common injuries occurring in infants as a complication of infusion therapy.1 Preterm infants have the most immature skin, which is easily damaged. An invasive treatment should be avoided, whenever possible. In our special operative unit of ulcers and difficult-to-heal wounds at the University of Rome, between 2004 and 2010, 26 premature babies who underwent extravasation of hypertonic fluid were enrolled in our study protocol (Table 1).Table 1: Study ProtocolOn the basis of our experience, we suggest the following practice of managing and treating extravasation injuries affecting preterm neonates. Once the injury has occurred, management should consist of immediate discontinuation of the infusion. The local treatment involves dilution of hypertonic solution, reduction of inflammation, and prevention of infection. The dilution is accomplished by injecting in total up to 10 or 20 ml of saline solution around the affected area. In case of edema and extended lesions, a washout technique should be performed. This technique consists of infiltration of saline solution that allows irrigation of the wound and free-flow drainage of the extravasated fluid through small skin puncture holes made with a needle in the area around the lesion. Silver sulfadiazine should be used in case of blistering and to prevent infections. Eschar formation can be observed at 1 or 2 weeks after extravasation and can require surgical management, which consists of débridement. In cases of partial- and full-thickness wounds, application of our treatment protocol and eventual skin grafting to the areas involved or flaps is used to repair the injuries. We suggest the use of Hyalomatrix PA,2–5 a dermal substitute composed of two layers. The internal layer is a biological matrix that acts by modifying the chemical-physical characteristics of hyaluronic acid, a naturally occurring extracellular matrix that plays an important role in the processes of tissue regeneration. When it comes in contact with the wound, it gradually releases hyaluronic acid that interacts with cellular functions, stimulating dermal regeneration. Furthermore, it provides a scaffold for cellular colonization and neoangiogenesis. The external layer, a transparent silicone film capable of transmitting vapor, allows monitoring of the wound, without changing medication. Hyalomatrix PA is used to cover the wound directly or to prepare the wound bed for subsequent skin grafting. We strongly believe that the best solution remains prevention. Unfortunately, there is a lack of information regarding the incidence and prevalence of extravasation injuries affecting preterm neonates. These tiny patients require especially effective pressure-sensitive equipment for the early detection of extravasation of intravenous fluids. Hyalomatrix PA allowed rapid healing of wounds (Figs. 1 and 2), thus delaying and, in some cases, avoiding surgery. We predict that if it is used in neonatal care units, and if detailed documentation is kept at all stages of the wound-healing process, it will be possible to provide a treatment based on appropriate experience and knowledge.Fig. 1: Wound is shown before the application of Hyalomatrix PA.Fig. 2: The result is shown at 21 days.Maria G. Onesti, M.D. Sara Carella, M.D. Michele Maruccia, M.D. Mariangela Ciotti, M.D. Nicolò Scuderi, M.D. Department of Plastic and Reconstructive Surgery, University of Rome "Sapienza", Rome, Italy DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.