Use of allogeneic platelet gel in the management of chemotherapy extravasation injuries: a case report

Abstract

Gaetano Di Costanzo,1 Giovanna Loquercio,1 Gianpaolo Marcacci,2 Vincenzo Iervolino,1 Stefano Mori,3 Arnolfo Petruzziello,1 Pasquale Barra,1 Carmela Cacciapuoti1 1Transfusion Service, Department of Haematology, National Cancer Institute “G Pascale” Foundation, IRCCS, Naples, Italy; 2Hematology-Oncology and Stem Cell Transplantation Unit, National Cancer Institute “G Pascale” Foundation, IRCCS, Naples, Italy; 3Department of Surgery, Melanoma – Soft Tissues – Head and Neck – Skin Cancers, National Cancer Institute “G Pascale” Foundation, IRCCS, Naples, Italy Abstract: The allogeneic platelet (PLT) gel offers to be a valid supportive measure in the management of chemotherapy extravasation injuries. We report a case of a 58-year-old patient with multiple myeloma enrolled for high-dose chemotherapy and autologous stem cell transplantation. As pretransplant therapy, the patient received induction therapy with bortezomib, adriblastina, and desametazone. A port was inserted in the vein on the back of the hand. After three cycles, the patient reported rapid development of redness, pain, and necrotic tissue in the left hand, and a diagnosis of extravasation was addressed. The patient presented a raw area on the back of the hand caused by cytotoxic/chemotherapeutic drug leakage because of the malposition of venous access devices. Skin ulcer was debrided, and the wound was reconstructed with a combination of local random rotational flap and abdomen skin graft. Two weeks later, a 20% skin flap necrosis was observed. In the context of wound healing, topical plasma-rich PLT gel is able to accelerate the regeneration and repair of tissue, so it was set out to assess PLT gel efficacy in this case. The PLT gel was applied topically once every 5 days, for a duration of 60 days on average. There were no adverse reactions observed during the topical therapy. Complete wound healing was observed after 12 PLT-rich plasma applications. No ulcer recurrence was noted in the patient during the follow-up period of 2–19 months. Keywords: growth factors, platelet gel, chemotherapy, management, extravasation