madman
Super Moderator
Summary: In the pursuit of success in sports, some athletes are not deterred by health risks associated with the (mis)use of black market preparations of dubious origin as performance-enhancing agents. Several studies published in the recent years demonstrated that anabolic-androgenic steroids, but also stimulants and growth hormones, are misused by numerous recreational athletes from all over the world. Trenbolone is an anabolic steroid routinely used in the finishing phase of beef production to improve animal performance and feed efficiency. A 35-year old male patient presented to our plastic surgery clinic after self-intramuscular administration of Trenbolone to the superior gluteal area bilaterally, which led to a full-thickness defect in a cone-like distribution. The wounds underwent surgical debridement and were treated locally with mafenide acetate irrigation and wound dressings. Closure was achieved by secondary intention healing. In this report, we discuss the first documented case of full-thickness skin and subcutaneous tissue necrosis after black market anabolic steroid injection. This illustrates a plastic complication and resolution of a widespread but seldom reported problem. (Plast Reconstr Surg Glob Open 2016;4:e1040; doi: 10.1097/GOX.0000000000001040; Published online 29 September 2016.)
We present a case of a 35-year-old male patient who self-injected Trenbolone intramuscularly to the superior gluteal area bilaterally. This led to a full-thickness defect in a cone-like distribution.
CASE PRESENTATION A 35-year-old healthy man was referred to our emergency room by his physician because of painful skin necrosis over the left buttock approximately 5×4cm and painful skin necrosis with purulent discharge on the right approximately 6.5×4cm (Fig. 1). The patient stated that he is a recreational “bodybuilder” and uses illicit substances to rapidly gain muscle mass. He has been using testosterone and various anabolic steroids for the past 4 years and 3 weeks before his referral changed his regimen to include a new steroid, Trenbolone. He recalled feeling pain upon injection, which led to him injecting more slowly and in an alternating pattern to both gluteus maximus muscles. The patient recalled persistent tenderness and induration in the injection sites followed by “darkening of the skin,” extreme pain, and secretion.
The patient was prescribed a course of first-generation cephalosporin, followed by a course of amoxicillin and clavulanic acid by his physician with no improvement and thereafter was referred to our center.
In the Plastic and Reconstructive Surgery Department, he underwent surgical wound debridement. The necrosis seemed to involve the skin, subcutaneous fat, and a small portion of the gluteus maximus muscle. Wound cultures were positive for Staphylococcus aureus and treated locally with mafenide acetate irrigation and wound dressings. Wound closure options included surgical closure by skin graft, local flaps, or healing by secondary intention. Because of the patient’s concern of further scarring and donor site morbidity, the wound was designated for healing by secondary intention. The patient was discharged with clean wounds and a hydrocolloid dressing 7 days after being admitted to the department. On ambulatory followup, the wound healed well with good granulation tissue filling the wound and peripheral epithelialization was observed shrinking the wound on the left to 3.5×3cm and the wound on the right to 5×3cm by 3 weeks after discharge (Fig. 2). At 6 weeks after discharge, wound dressings were changed to polyurethane (Fig. 3) and complete epithelialization was observed by 2 months after discharge (Fig. 4). No complications were noted.
CONCLUSIONS
Because of the prevalent misuse of performance-enhancing drugs and the illegal nature of this practice, we believe professional and recreational athletes presenting with full-thickness wounds warrant a high index of suspicion of AAS misuse. The plastic reconstructive approach is standard in that the wound should be debrided and any infection, local or systemic, treated followed by reconstruction with the addition of using the experience as a strong deterrent from future drug abuse.
We present a case of a 35-year-old male patient who self-injected Trenbolone intramuscularly to the superior gluteal area bilaterally. This led to a full-thickness defect in a cone-like distribution.
CASE PRESENTATION A 35-year-old healthy man was referred to our emergency room by his physician because of painful skin necrosis over the left buttock approximately 5×4cm and painful skin necrosis with purulent discharge on the right approximately 6.5×4cm (Fig. 1). The patient stated that he is a recreational “bodybuilder” and uses illicit substances to rapidly gain muscle mass. He has been using testosterone and various anabolic steroids for the past 4 years and 3 weeks before his referral changed his regimen to include a new steroid, Trenbolone. He recalled feeling pain upon injection, which led to him injecting more slowly and in an alternating pattern to both gluteus maximus muscles. The patient recalled persistent tenderness and induration in the injection sites followed by “darkening of the skin,” extreme pain, and secretion.
The patient was prescribed a course of first-generation cephalosporin, followed by a course of amoxicillin and clavulanic acid by his physician with no improvement and thereafter was referred to our center.
In the Plastic and Reconstructive Surgery Department, he underwent surgical wound debridement. The necrosis seemed to involve the skin, subcutaneous fat, and a small portion of the gluteus maximus muscle. Wound cultures were positive for Staphylococcus aureus and treated locally with mafenide acetate irrigation and wound dressings. Wound closure options included surgical closure by skin graft, local flaps, or healing by secondary intention. Because of the patient’s concern of further scarring and donor site morbidity, the wound was designated for healing by secondary intention. The patient was discharged with clean wounds and a hydrocolloid dressing 7 days after being admitted to the department. On ambulatory followup, the wound healed well with good granulation tissue filling the wound and peripheral epithelialization was observed shrinking the wound on the left to 3.5×3cm and the wound on the right to 5×3cm by 3 weeks after discharge (Fig. 2). At 6 weeks after discharge, wound dressings were changed to polyurethane (Fig. 3) and complete epithelialization was observed by 2 months after discharge (Fig. 4). No complications were noted.
CONCLUSIONS
Because of the prevalent misuse of performance-enhancing drugs and the illegal nature of this practice, we believe professional and recreational athletes presenting with full-thickness wounds warrant a high index of suspicion of AAS misuse. The plastic reconstructive approach is standard in that the wound should be debrided and any infection, local or systemic, treated followed by reconstruction with the addition of using the experience as a strong deterrent from future drug abuse.
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