SKIN NECROSIS AND VENOUS THROMBOSIS FROM SUBCUTANEOUS INJECTION OF CHARCOAL LIGHTER FLUID (NAPTHA)

A 33 year-old white man injected approximately 4 cc of charcoal lighte r fluid (99.4% naptha/0.6% inert ingredients) subcutaneously into his left antecubital fossa. The injection resulted in the toxic necrosis o f his volar forearm skin extending proximally to mid-humerus and dista lly to the metacarpophalangeal joints of the left hand dorsally over a 6-day period. The patient ultimately required extensive surgical debr idement, secondary operative closure, and approximately 150 cm(2) of s plit-thickness skin grafting. This case demonstrates the potential for widespread, delayed toxic necrosis of the skin resulting from subcuta neous injection of naptha. This patient's case appears to represent th e most severe and widespread case of toxic necrosis of the skin result ing from the subcutaneous injection of hydrocarbons reported in the li terature. This case also demonstrates extensive toxic thrombophlebitis not reported in prior cases involving subcutaneous injection of hydro carbons. Copyright (C) 1998 by W.B. Saunders Company.