Infections of the extremities as a complications of the intravenous use of psychoactive substances

Abstract

Introduction: Infections on the extremities are a common occurrence in psychoactive substance addicts who use the drug intravenously. A significant risk of infection is present due to non-sterile conditions and/or incorrect injection of substances. Other contributing factors in this group of patients are comorbidities, impaired body defense mechanisms, harmful habits, and a lifestyle inconsistent with recommendations for a healthy life. Surgical treatment is essential in solving these complications, but also in repairing skin and soft tissue defects. In the professional literature, in both psychiatric and surgical specialties, few studies dealt with infections as complications in psychoactive substance addicts and surgical procedures in their treatment. Material and method: A retrospective analysis of infections as a complication on the extremities in addicts of psychoactive substances hospitalized in one center for two years was performed. Results: A group of 24 patients was analyzed. All patients were long-term intravenous drug users. The lower extremity was more often affected by infections (which were registered in 14 or 58.33% of patients), while changes on the hands were registered in 10 or 41.67% of patients. Affected limb parts were: the upper arm (4 or 16.67%), forearm (7 or 29.17%), arm (1 or 4.17%), the upper part of the leg (5 or 20.83%), the lower part of the leg (6 or 25%) and foot (3 or 12.5% of addicts). Acute manifestations of infections were: abscesses (8 or 33.33%), phlegmon (5 or 20.83%), cellulitis (2 or 2.24%), tissue necrosis (2 or 2.24%), necrotic fasciitis ( 3 or 12.5%), lymphadenitis (4 or 16.67%) and phlebitis (4 or 16.67% of addicts). All patients were treated surgically during hospitalization; initial surgical treatment included: incisions, debridement, necrectomy, application of negative pressure, sequestrectomy, instillation, and amputation; 13 (54.17%) patients were treated using reconstructive surgical procedures. Conclusion: Surgical treatment of infectious complications in intravenous drug users is necessary in cases of a developed clinical picture and the presence of a systemic infectious response. Surgical treatment is an essential element in the prevention and treatment of infection and the reconstruction of major skin defects.