A devastating complication of ‘skin popping’

A 40-year-old gentleman presented with a 7-day history of a painful ulcer over the lateral aspect of his right lower leg. He was an intravenous drug user for the last 15 years and on a methadone programme for the previous 12 months. He admitted to the practice of “skin popping” (injecting drugs subcutaneously) over his right leg as he had exhausted all of the venous access sites. The ulcer had been present for the last 2 years and he did not seek any medical attention as this area was used as a “shooters patch” to inject illicit drugs. Clinical examination revealed a 22 15 cm ulcer over the lateral aspect of his right lower leg with a central area of necrosis approximating 12 8 cm (Fig. 1). The base of the ulcer extended down to the fibula. Radiographic examination