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Isolated limb perfusion (ILP) for malignant melanoma

Follow-up

The patient is mobilized from the first postoperative day.

Normal postoperative stay is 3 to 7 days depending on side effects and/or complications. 

Local side effects

Side effects are graded according to the Wieberdink's classification:

Wieberdink's classification

Grade

Description

I

No reaction

II

Mild edema and/or erythema

III

Prominent edema and/or erythema with blisters and some limited movement. 

IV

Comprehensive epidermolysis and/or visible damage to deep tissue leading to limited function,

threatening or developed compartmental syndrome.

V

Reaction requires amputation.

  • Mild side effects develop usually after 2 to 3 days after ILP in 90% of patients. Moderate to serious side effects involve 25 to 40 % of patients.
  • Extremity-threatening complications with serious tissue damage and edema occur in less than 10 % of patients. In rare cases, amputation is necessary.

Most side effects after ILP treatment spontaneously regress after 2 to 3 weeks.

Vascular complications such as thrombosis after arteriotomy occur in about 2.5 %. The incidence of DVT is about 10 % despite heparinization during the treatment. Nerve toxicity manifests itself as pain or paresthesia 2 to 3 weeks after treatment in 25 to 40 % of patients. These usually regress within a few months. Long-term neuropathy occurs more rarely.

Systemic side effects

Most systemic side effects are caused by leakage from the perfusion fluid to the circulation system during treatment. Despite complete isolation and thorough rinsing afterwards, there may still be remains of medication in the tissue or in intravascular components which can spread to the entire body when circulation is reestablished.

Systemic toxicity from melfalan perfusion is limited if the systemic leakage does not surpass 10%.

Systemic leakage of TNF can lead to serious cardiovascular, metabolic, and hematological complications.

Follow-up

The patient is checked clinically every other week for 3 months. Thereafter every third month for 1 year. Follow-up with MRI of the extremity is performed after 4 and 8 weeks and only when a large volume is involved. 

For partial remission or locoregional relapse, new ILP treatment should be considered.

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