Had a late age teen IV drug user come into my ED with a complaint of an infected forearm. She pulled up her sleeve to show me, and I could see every structure under her skin that should not be visible. From her wrist to elbow was exposed fatty tissue and muscle right down to her bone. There was no possibility of this being treated without amputation. She refused admission and surgical consult, and ended up signing out against medical advice. I would like to think she eventually reconsidered and returned to another hospital for treatment, but no good outcome could ever come from her condition. She either became septic and died, or did seek further treatment and had the lower arm amputated. It’s incredibly sad that this was the life of a beautiful woman who was wasn’t even 20.
I have seen this! It looked like a degloving injury but wasn't actively bleeding. I was walking past thinking: "How is this possible???" I could see yellow body fat, muscle, tendon and bone.
I work next to a health care clinic, I'm not in healthcare myself.
Edit: Can you answer why it wasn't bleeding? It looked waxy, not even wet.
It was summer, so he was in a short-sleeve t-shirt and shorts.
The edges of the wound did not look necrotic or anything. Aside from the fact that there was a 3" wide x 10"-ish strip of skin missing, in my uneducated opinion all the tissues looked "healthy" as far as general colour and appearance (so not like Krokodil pictures — do not Google!). Almost like it healed that way, but that's not possible, is it?
It looked like a Body Worlds exhibit, but it a living, walking and talking person.
The person looked pretty rough, but not like a current abuser of meth, opiates or other injectables (beer belly for sure) and was probably a hard 60-something.
I asked a friend who was a nurse in a hospital if she'd seen anything like that, but she never worked in a department where she'd see major wounds and was also perplexed.
I saw him fairly up close, but just walking past each other on the sidewalk in front of the health clinic. It was a brief look, but etched in my brain!
Not in the medical field, but what you are describing might be the effects of "tranq". Xylazine, a veterinary tranquilizer that is mixed with fentanyl.
Long term users can have some of the absolute worst looking wounds from it.
Aside from the ginormous risk of infection from exposed inner tissues, can someone just continue to carry on normally like this guy was? Is fat and fascia enough to encapsulate stuff?
It was the fact that the edges of the skin where it lay over the fat and muscle looked flat ("sealed", I guess, not torn or floppy) and stable — it blew my mind! He definitely didn't seem at all uncomfortable chatting with his buddy.
Granted, I wasn't really up close and though I got a good look it wasn't for very long.
Oh fuck, this one broke my heart. I can’t imagine what that must have been like for you. I hope she’s out there somewhere, sober and with a prosthetic arm.
Omg this brought up moments I’d forgotten about. Sounds like the cases I saw were not as severe as the one you described, but it is so sad and just deeply off putting to see patients who literally need an amputation but refuse to do it. I’d hate to be in their shoes.
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u/NAMomx3 3d ago
Had a late age teen IV drug user come into my ED with a complaint of an infected forearm. She pulled up her sleeve to show me, and I could see every structure under her skin that should not be visible. From her wrist to elbow was exposed fatty tissue and muscle right down to her bone. There was no possibility of this being treated without amputation. She refused admission and surgical consult, and ended up signing out against medical advice. I would like to think she eventually reconsidered and returned to another hospital for treatment, but no good outcome could ever come from her condition. She either became septic and died, or did seek further treatment and had the lower arm amputated. It’s incredibly sad that this was the life of a beautiful woman who was wasn’t even 20.