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Treatment of “Trash-Hand” Following Intraarterial Injection of Drugs in Addicts

As intravenous drug abusers grow older, they develop a paucity of superficial veins for access, which compels them to guess at the location of deeper veins for access. On occasion, the drug is injected into an artery, resulting in limb-threatening ischemia. Five patients (3 men/2 women) with an average age of 35.6 years (range twenty-eight to forty-three years) who inadvertently injected illicit drugs into an upper extremity artery developed a “trash-hand.” The injected drugs include crushed meperidine (2), crushed codeine (2), and crushed haloperidol (1). The patients initially treated with heparin alone (2) or dextran-40 alone (1) had progressive ischemia resulting in amputation of their hand. Patients initially treated with a combination of heparin and dextran-40 had limb salvage. This small group of patients demonstrates that the combination of heparin and dextran-40 may be advantageous for treatment of patients with “trash-hand.”