Abstract
Background: Intravenous drug abuse is an anciently known health and social problem worldwide. The nonsterile application of addicting drugs leads to severe life-threatening vascular complications. The femoral triangle is an easy target for this purpose. Groin necrotic fasciitis (NF) with vessel necrosis is a challenging diagnosis that requires prompt treatment. Case Report: A 44-year-old male intravenous drug user presented for a left groin pain. He was diagnosed by computed tomography scan to have necrotizing fasciitis. Urgent debridement was performed and identified infected and necrotic ruptured femoral vessels without active bleeding. Debridement with vessel ligation was performed, and delayed revascularization was planned. The patient was admitted six weeks later with a left fifth toe necrosis and delayed arterial revascularization was performed via extra-anatomic trans-obturator ilio-femoral anastomosis. The patient had a favorable follow-up. Conclusion: NF in intravenous drug abusers should always be taken into consideration when a patient presents with groin pain and swelling. Urgent surgical control should be established. Extra-anatomical trans-obturator ilio-femoral anastomosis is a good option for revascularization.
Highlights
Conclusionnecrotic fasciitis (NF) in intravenous drug abusers should always be taken into consideration when a patient presents with groin pain and swelling
Intravenous drug abuse (IVDA) is an anciently known societal and health crisis.With the increasing availability of intravenous (IV) drugs, such as heroin, this problem is becoming more notable especially due to its possible complications on the vascular system [1].The femoral triangle is an accessible and simple site for IVDA
Complications at this area can vary from simple needle site infection to more serious events such as cellulitis, thrombophlebitis, bacterial endocarditis, arterial pseudoaneurysm rupture or infection, necrotizing soft tissue infection, hepatitis, pulmonary septic emboli, ulcerations, and gangrene [1]
Summary
Complications of IVDA at the femoral triangle are challenging cases. NF is a lifethreatening condition that needs wise decision making and intervention. Due to the lack of adequate data in literature, there is still no consensus on the optimal management nor on the type of graft to use. Tissue debridement plus ligation of the vessels followed by a delayed extraanatomical revascularization is an acceptable approach with negative pressure wound therapy helping to assist in shortening the time of healing
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