Topicals that can be used include 2% nitroglycerine ointment for a pressor (epinephrine or dopamine) infiltration. This must be used carefully, as it can cause hypotension. Silvadene can be used, but because of the sulfa should probably not be used in premies. Hydrocolloid dressings can also be applied. Antidotes, like hyaluronidase, to disperse the infiltrate into the surrounding tissue have been used. Phentolamine has been used for dopamine or epinephrine extravasation as well, but if you inject phentolamine into the site, it can cause vasodilatation and hypotension and should only be done very selectively.
Surgery's role here should only be consultative. In the published reports, only 25% of NICUs have protocols for the treatment of this. I think therapy should be conservative. Unfortunately, I have seen a number of times where plastic surgeons have been involved in this and, while I'm not being critical of plastic surgeons, usually they have very little experience in taking care of infants. They look at it as being a full thickness injury that needs to be excised, not understanding that if it is left alone, it will separate spontaneously, contract and close in almost every instance. Surgery done on these children is very dangerous because there is no subcutaneous tissue, so if you excise it, you are right down on the extensor tendons. If you remove the paratenon, which is the surface of the tendon that allows it to glide, then you have a fixed and frozen tendon with a bad and permanent outcome.
I would really encourage you to be conservative about this, restore the circulation, elevate the extremity and the majority of these will heal without a skin graft with minimal scarring.
Now, having said that, you can have more problems. The accompanying pictures show a patient with an IV slough that did require a skin graft.