It Takes a Village

The Management of Extreme Sequelae of Skin Popping

C.J. Michet, BA; Courtney Whitelock, BS; Nicole Siparsky, MD, FACS


Wounds. 2021;33(1):9-19. 

In This Article


This is a case series of 5 heroin addicts who presented to Rush University Medical Center with infected SP ulcers between 2017 and 2019. Each case was selected for inclusion in this series because of the dramatic nature of the disease observed. Each patient reported using heroin or tested positive for heroin on admission, and each admitted to practicing SP or maintained a shooter's patch in the lower extremity.

In each case, a multidisciplinary approach was employed to care for the patient. Members of the departments of medicine, surgery, nursing, addiction medicine, infectious disease, physical/occupational therapy, and social work collaborated in the complex management of each patient. Each specialist team addressed issues under their purview, as detailed in Table 1. In each case, the patient underwent supportive medical care, antibiotic therapy, surgery for source control and tissue culture, postoperative pain management with OUD therapy (unless declined by patient), and dressing care. The surgical management of each patient's disease followed standard evidence-based surgical practice, dictated by severity of infection, depth of infection, and the patient's comorbid conditions.