[Case Report] Skin Necrosis Due to IV Infiltration in a 7-Month-Old Infant Girl: Successfully Treated Without Skin Grafting Using Moist Wound Healing

Introduction

The patient is a 7-month-old infant girl, a truly adorable baby.
She was admitted to the pediatric department of Hospital
A due to influenza.
During her hospitalization, a large-volume IV infiltration (extravasation) occurred,
resulting in skin necrosis around her right wrist joint.

Initial Treatment Course
A consultation was made with Dr. ○○ of the Dermatology Department
at Hospital B,
affiliated with ○○ University School of Medicine.
Topical treatment with Dermovate ointment
and gauze dressing was initiated.
However, no improvement was observed.
The treatment was changed by Hospital A to
Gentacin ointment with gauze,
but the wound worsened and eventually progressed to black necrosis.
The ointment was later switched to Geben cream.

Confusion and Misdiagnosis at Other Facilities

The attending physician at Hospital A informed the parents that
they were providing moist wound healing,but in reality,
the use of gauze dressings contradicts the principles
ofmoist wound care.
Furthermore, Geben cream is never used by physicians
who practice true moist wound healing.

At another clinic (Clinic C), the physician told the parents:

“You must perform a skin graft immediately,
or the situation will become critical.”

This caused considerable fear and confusion for the parents.

Treatment Strategy at Our Clinic

Upon presentation to our clinic,
we explained the following points to the patient’s mother:
・A detailed explanation of Natsui-style moist wound healing
・Daily showers and bathing are allowed
・The necrotic tissue would naturally soften and dissolve
within about two weeks, followed by epithelialization
・Skin grafting is unnecessary, and complete healing can be expected

Medical Consideration

Skin necrosis due to IV infiltration is considered
pathophysiologically similar to low-temperature burns.
This was my first case of necrosis caused by IV extravasation,
so I sought guidance by emailing Dr. Makoto Natsui,
a renowned advocate of moist wound healing.
Despite his busy schedule,
he kindly responded promptly and confirmed
that my proposed treatment plan was appropriate.
His support was extremely reassuring,
and I am deeply grateful for his guidance.

[Update] Reposting a Case of Skin Necrosis
Caused by IV Infiltration
(Originally Posted: May 9, 2016)

This case was originally experienced around 2015,
approximately 10 years ago.
Recently, we have seen an increasing number of inquiries
and consultations from individuals
who have developed skin necrosis caused by IV infiltration.
In response, we have revised and reorganized
the original blog post published on May 9, 2016,
and are reposting it here.
We hope this case report will serve as a helpful reference
for those facing similar symptoms.

I am using a translation tool for this English version,
so some parts may be unclear.
Thank you for your understanding.