We present a retrospective analysis of 32 patients admitted over a 5-y
ear period to a metropolitan regional trauma center with recently indu
ced subcutaneous (''skin pop'') illicit drug injectional injuries invo
lving the hand, Cocaine derivatives were the most frequently reported
illicit drug used (75%). All patients had local disease manifested by
subcutaneous abscess formation, and several had regional disease (celi
ulitis, lymphangitis, or lymphadenapathy), but only one patient had sy
stemic illness. Microbiological analysis revealed endogenous integumen
tary and oral flora sensitive to oral preparations of several antibiot
ic medications including cephalosporins. Primary therapy included intr
avenous administration of antibiotic medications in all instances and
simple incision and drainage under local anesthesia in 26 patients (81
%). Six patients (19%) required more radical operative therapy. All pa
tients were hospitalized and recovered without sequelae, with preserva
tion of hand function after follow-up evaluation, which ranged from we
eks to months, except for 1 patient who required digital amputation be
cause of necrosis. Although the issue of compliance in terms of wound
and general medical care for this patient population is problematic, a
nalysis of the data suggested that patients with illicit drug injectio
nal injuries of the hand confined to subcutaneous regions could be eff
ectively and safely managed in outpatient settings by simple wound car
e and orally administered cephalosporin medications.