Cutaneous crospovidone reaction secondary to subcutaneous injection of buprenorphine

Marka, Arthur; Hoyt, Brian; Dagrosa, Alicia T.; Barton, Dorothea T.; Kim, Andrew; Linos, Konstantinos; Yan, Shaofeng

doi:10.1111/cup.13624

Cited by 6 publications

(2 citation statements)

References 16 publications

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“…Necrotic tissue, ulcers, and poor wound healing typically occur secondary to the injection of exogenous materials that the active drug was “cut” with 16,21,22 . On a histologic level, the tissue adjacent to the site of the injection can demonstrate endothelial cell injury, occlusive thrombi, and subcutaneous abscesses with extension of inflammation into the dermis 21,23,24 . When patients engage in “speedballing,” a related technique in which vasoconstrictors such as cocaine are mixed with heroin to further delay drug absorption, 25,26 poor wound healing may occur secondary to insufficient tissue vascularization.…”

Section: Discussionmentioning

confidence: 99%

“…16,21,22 On a histologic level, the tissue adjacent to the site of the injection can demonstrate endothelial cell injury, occlusive thrombi, and subcutaneous abscesses with extension of inflammation into the dermis. 21,23,24 When patients engage in "speedballing," a related technique in which vasoconstrictors such as cocaine are mixed with heroin to further delay drug absorption, 25,26 poor wound healing may occur secondary to insufficient tissue vascularization. In the chronic stages, wounds become fibrotic, depressed, and hyperpigmented papules as part of the wound remodeling process.…”

Section: Pathogenesismentioning

confidence: 99%

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Skin Popping for the Hand Surgeon

Shih

Francoisse

et al. 2023

Ann Plast Surg

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Introduction Subcutaneous injection of illicit drugs, colloquially known as skin popping, is associated with skin and soft tissue infections of the upper extremity. Sequelae of these infections often present to hand surgeons in the late stages of disease, are associated with challenging clinical scenarios, and are a significant burden to both patients and providers. The authors present an illustrative case and review the literature regarding this growing phenomenon in upper extremity surgery. Methods A case report detailing the surgical reconstruction of a large forearm wound in the setting of intravenous heroin use and skin popping is presented. Search terms related to upper extremity subcutaneous drug injection were used to find relevant articles in PubMed and EMBASE. A total of 488 articles were found, with 22 studies meeting the inclusion criteria. Results In this case report, the patient had a long history of skin popping to the forearm and presented with a chronic wound with exposed bone. The patient was treated with serial debridement, bony fixation, intravenous antibiotics, and soft tissue coverage using an arteriovenous loop and a muscle-only latissimus flap. Literature review yielded 22 studies comprising 38 patients with 55% (11/20) women and age range of 23 to 58 years. Heroin was the most commonly used drug (50.0%). The most common presentation was soft tissue infection (6/20 patients), manifestations of noninfected wounds (5/20), and wound botulism (4/20 of patients). Seventy percent of patients presented with multiple injection sites. Surgical management was described in 18% of cases, with all but one case describing drainage and debridement techniques. Only one case of formal reconstruction using a dermal template was described. Conclusions Skin popping infections have unique pathogenesis, presentation, and management patterns that hand surgeons must be aware of when treating these patients. A literature review revealed a relative paucity of reports regarding risk factors and surgical management of “skin popping” sequelae. If patients are reconstructive candidates, complex reconstruction requiring free tissue transfer may be warranted.

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Section: Discussionmentioning

confidence: 99%