title: Skin ulcer caused by venous extravasation of heroin.
abstract: The accidental leakage of the compound, in this case heroin, from the veins where it is injected, causes the formation of tissue lesions. Similar mechanisms lead to progressive tissue necrosis, which, if not immediately treated, results in the loss of the relevant function. A 57-year-old man presented a skin lesion on the posterior region of the left forearm with extensive necrosis of skin and subcutaneous layer involving the underlying muscle planes, caused by a venous extravasation of heroin that he reports having injected himself. The wound size is 15 × 10 cm; it had a sanious, fibrinous, secreting and smelly bottom. In this period, the patient was subjected to daily focused dressing before debridement of the lesion through a collagenase plus hyaluronic acid ointment: Bionect Start®; (FIDIA Pharmaceutical, Abano, Italy). The therapeutic choice was rewarded with a complete resolution of the wound through a non-invasive technique and over a short period. Avoiding the hospitalisation of the patient achieved a reduction of risks for him and of the costs for the National Health Service (NHS). The Bionect Start®; (FIDIA Pharmaceutical) as well as allowing the healing of the wound also decreased significantly the pain felt by the patient, the amount of exudate and the bad smell improving in a non-negligible way his quality of life.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome "Sapienza", Policlinico Umberto I, Viale del Policlinico, Rome, Italy.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Onesti
authors.forename: Paolo
authors.initials: P
authors.lastname: Fioramonti
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fino
authors.forename: Diego
authors.initials: D
authors.lastname: Massera
authors.forename: Vittoria
authors.initials: V
authors.lastname: Amorosi
authors.forename: Nicolo
authors.initials: N
authors.lastname: Scuderi
mesh_terms: D000287:Administration, Topical; D001458:Bandages; D003646:Debridement / Q000379:methods*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications*; D005500:Follow-Up Studies; D003932:Heroin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009824:Ointments; D012883:Skin Ulcer / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy; D055675:Viscosupplements / Q000008:administration & dosage
chemical_list: D009824:Ointments; D055675:Viscosupplements; D003932:Heroin; D006820:Hyaluronic Acid
keywords: Bionect Start®; Collagenase; Extravasation of heroin; Hyaluronic acid; Skin lesion