HAND INJURIES SECONDARY TO SUBCUTANEOUS ILLICIT DRUG INJECTIONS

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.