title: Subcutaneous Injection of Percocet: A Case of Severe Soft Tissue Loss.
abstract: Prescription drug abuse ranks as the second most common class of illicit drug use in the United States, and one mechanism of opiate abuse involves intravenous injection of enteral narcotics such as oxycodone or hydrocodone. The authors describe a patient who sustained significant soft tissue necrosis after intravenously injecting a solution made from crushed enteral narcotics, with a focus on the operative course that resulted due to a delay in initial definitive treatment. The patient's wounds encompassed 8% total body surface area and covered 247 cm2. A 55-year-old female was admitted to the burn unit (West Penn Burn Center, Western Pennsylvania Hospital, Pittsburgh, PA) after she initially presented with infection and cellulitis to her bilateral upper extremities 3 weeks after intravenously injecting herself with crushed oxycodone/acetaminophen. She underwent numerous sequential operative repairs including initial debridement, placement of dermal replacement templates, and several split-thickness autografts and xenografts. Her total length of stay was 59 days, broken into an initial 47-day stay, and a subsequent 12-day readmission due to graft failure secondary to poor follow-up. As the number of prescription drug abusers rises, it is possible that an increase in attempts to intravenously abuse enteral narcotics may also rise. As such, burn centers should be prepared for the extent of potential limb necrosis and the operative treatment that may ensue.
authors.affiliation: Lake Erie College of Osteopathic Medicine, Erie, PA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Baskin
authors.affiliation: Lake Erie College of Osteopathic Medicine, Erie, PA.
authors.forename: Christine
authors.initials: C
authors.lastname: Abboud
authors.affiliation: University of Pittsburgh School of Medicine, Department of Plastic and Reconstructive Surgery, Pittsburgh, PA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Chen
authors.affiliation: West Penn Burn Center, Western Pennsylvania Hospital, Pittsburgh, PA.
authors.forename: Eric
authors.initials: E
authors.lastname: Tolchin
authors.affiliation: West Penn Burn Center, Western Pennsylvania Hospital, Pittsburgh, PA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Kelly
authors.affiliation: West Penn Burn Center, Western Pennsylvania Hospital, Pittsburgh, PA; email: AAballay@wpahs.org.
authors.forename: Ariel M
authors.initials: AM
authors.lastname: Aballay
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D002481:Cellulitis / Q000139:chemically induced / Q000473:pathology; D003646:Debridement / Q000379:methods; D004338:Drug Combinations; D003875:Drug Eruptions / Q000209:etiology / Q000473:pathology / Q000601:surgery; D005260:Female; D006084:Graft Rejection; D006801:Humans; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects*; D009336:Necrosis / Q000139:chemically induced / Q000473:pathology / Q000601:surgery; D010098:Oxycodone / Q000009:adverse effects*; D063487:Prescription Drug Misuse / Q000009:adverse effects*; D016038:Skin Transplantation / Q000379:methods; D018461:Soft Tissue Infections / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D017695:Soft Tissue Injuries / Q000139:chemically induced / Q000473:pathology / Q000601:surgery; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000473:pathology
chemical_list: D018712:Analgesics, Non-Narcotic; D004338:Drug Combinations; D009294:Narcotics; C514822:oxycodone-acetaminophen; D000082:Acetaminophen; D010098:Oxycodone