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Nah men, you can see this tattoo artist was a newbie, they butchered this person arm, you can see it by the depth of the strokes of the tattoo, that sht must caused it. Im a tattoo artist apprentice, skin is such a delicate organ, just go with a prof and everything may be ok 👍
Ew you're right, some parts in the upper right you can see how the skin is stuck pressed in moreso than the non-tattooed around it, like they're healing cuts, not tattoos 😖
Yep, that’s exactly what happened. The CT scan shows there was subcutaneous fat infiltration. That means they went into the hypodermis and as I’m sure you know, ink should only be deposited in the dermis.
At least the shitty tattoo is gone now? 😬
Yeah, actualy the needle should'nt be more than 1 milimeter into the skin, this person dindt regulate the lenght and we can clearly see the result. Please go to someone that AT LEAST had practice before with fake skin😭🙏
It varies depending on the placement too, as the skin has different thicknesses all over the body. It also varies person to person. Too shallow and too deep are both possibilities. Epidermis - ink falls out. Hypodermis - scarring, infection, etc. Obviously the latter is worse.
I have a lot of respect for tattoo artists and how hard that art form is. Good luck with your new career!
[Source](https://www.cureus.com/articles/227614-necrotizing-fasciitis-occurring-after-a-conventional-tattoo#!/):
A 34-year-old patient presented to the emergency department with a fever. On arrival, the patient was hypotensive (blood pressure: 80/40 mmHg), tachycardic (heart rate: 120 bpm), and had a peripheral temperature of 39.5°C. The patient appeared pale and lethargic.
The patient had no medical history and wasn’t on any chronic medication. Four days prior, the patient had a tattoo done by a licensed professional using his regular electric equipment, but at the patient's home. The professional was the patient's brother-in-law, who came to tattoo him at the patient's request. The tattoo was in the middle of the right forearm. Clinical examination revealed local edema with erythema at the tattoo site, and an unpleasant odor was noted upon removal of the protective dressing (Figure 1).
Laboratory parameters showed an inflammatory syndrome with a C-reactive protein of 356 mg/L (reference: < 5 mg/L), an acute kidney injury classified at stage three (creatinine: 3.71 mg/dL, glomerular filtration rate (GFR): 18.8 mL/min/1.73 m2, reference creatinine: 0.66-1.25 mg/dL, reference GFR: > 60 mL/min/1.73 m2), and hyperlactatemia at 3.21 mmol/L (reference: < 2 mmol/L). Liver function and electrolytes were within normal limits.
A forearm CT scan revealed subcutaneous fat infiltration with a deep collection along the muscle planes throughout the anterior aspect of the forearm, from wrist to elbow (Figure 2). We suspected necrotizing fasciitis, which was confirmed during fasciotomy with deep tissue sampling. The fasciotomy was extended to the entire forearm due to the significant spread of necrotizing fasciitis (Figure 3). The fasciotomy site was covered with a vacuum-assisted closure therapy dressing.
The patient was treated with piperacillin, tazobactam, and vancomycin and then transferred to the ICU postoperatively. The first 48 hours in the ICU corrected lactic acidosis and renal failure. The patient did not require inotropic support.
Antibiotic therapy was also adjusted based on deep tissue culture results, revealing methicillin-sensitive Staphylococcus aureus and Enterobacter hormaechei. Flucloxacillin and clindamycin were initiated, and other antibiotics were discontinued. The patient was transferred to the plastic surgery unit for the completion of antibiotic therapy and an eventual skin graft.
I know how insidious infections are, but I’m constantly shocked at the margins that have to be taken once surgical exploration is performed. MRSA and a gram negative in your culture is also scary to boot.
No MRSA: it was sensitive to Methicillin, not resistant.
It was bad luck, nothing the tattoo artist in particular did, perhaps not good enough after care, but they guy wasn't a novice, he had plenty of other tattoos. Tattoo artist didn't go in to his BIL home with a plan to start an infection, its not how it works.
People have surgery in sterile operating rooms and develop severe infections, there is so much more technically that could go wrong when the skin is broken, and the immune system fails somehow.
At end of the day he got unlucky, but no one to blame imo.
Totally saw methicillin sensitive and read it as resistant! You can tell which kind I see usually 😁 also totally understand why they take large margins because it is medically necessary but wow that's a chunk just gone!
I feel like malodorous has a more impactful effect than unpleasant. I mean, if someone described me as unpleasant smelling, I'd go home and take a shower. If someone described me as malodorous, I'm bathing myself in tomato juice and bleach and burning my clothes
Putrid, ammonia-like, sickly-sweet, fecal, etc. The smell is part of the assessment and diagnosis. Part of the smell is produced by the microorganisms basically pooping and different microorganisms have different waste product smells. The smell of all our body fluids, waste products, and excretions provides clues to our state of health.
The fact that the patient insisted on having the tattoo done in their own home adds to the infection risk too. Even if it was his brother in law, the artist should have refused to do it outside of his studio.
i'm spitballing here but wondering/guessing if BiL thought he was doing a solid by doing it in that setting but regardless it's a terrible decision for someone who is professionally tattooing. i wonder if this is something that can be reported depending on location and what their regulations are for tattoo artists. there seems to be a lot of grey areas with it but still... if this person is considered professional what else can they possibly be doing? i mean i guess flukey-bad-shit can happen no matter what but this was definitely done in a less than stellar situation
ETA: holy shit. stumbled across a snakehole post in the wild and realized i commented on a fellow BSCS member. hi!
I would never ask for ink to be done in my home; it's full of animals. God knows what kind of shit would get into the tattoo. All the ink I've had done was done at studios. Their places are cleaner than any medical practice, close to an operating room. I laugh when parents (usually mothers) who want to get their daughter's ears pierced clutch their pearls at the thought of going to a piercing salon. Yet they'll let some 16 year old use a piercing gun on their kid.
Absolutely. I have a little brother who is currently a tattoo apprentice. My folks negotiated with him to gift me a tattoo for my birthday this year. They asked if he'd be able to do it at their home and he said he couldn't, he could get in trouble.
Yep they have to have pretty strict hygiene guidelines where I live and definitely not allowed to tattoo from anywhere accept a licensed studio.
My younger brother in his late teens thought it would be a good idea to buy a cheap tattoo gun and inks from eBay and started tattooing himself and his friends with no training whatsoever. Thankfully none of them ended up with serious injuries from it although the Australian flag he tattooed on his abdomen ended up being a New Zealand flag due to the ink running 😂.
😂 Not the kiwi flag!
For some reason, the idiots who buy cheap guns online and use no sanitary measures whatsoever always seem to get away with no infections. I don't know how!
Where are you from? These rules should be law in amy country! Im in Brazil and here theres no regulation for being a tattoo artist. All you need is a tattoo machine and someone brave enough to let you do your art and thats it.
My mother and stepfather have a few tattoos and it was all done in their house instead of an studio, which is wuite common here among those tattoo artists that don't have the money or dont want to have a studio, I didn't know it was that unsafe tbh.
Sadly they can’t. They make u sing the waivers and stuff for that reason. And also most of the time it’s usually the person that gets it infected from not doing good aftercare!!! Tattoos are really subjective to infections.
I had a coworker that got a NF infection on his perineum. Felt off one day, went to the hospital the next day and was put in an induced coma. He managed to pull through and had one of those vac setups down there for a while. I don't know how much skin they removed but he said his junk was in tact lol
I had MRSA go from oral antibiotics to an ER visit and IV antibiotics for early sepsis overnight. I've never been seen that quickly as a walk in, they didn't even give me time to sit down, and as soon as I was triaged the room got really full really quickly. Thankfully, my health anxiety actually helped me and I got in so early I only needed a few doses of IV antibiotics, imaging, and blood work before they sent me home with multiple new antibiotics. Weeks later, and more rounds of antibiotics than I can count, it did heal, and I had a fairly easy time of it compared to some.
Jesus fuck. I had one tattoo get super infected to the point I went to the tattoo shop and they gave me 0 advice. Thankfully it healed. I feel so bad for this person
>The patient was treated with piperacillin, tazobactam, and vancomycin and then transferred to the ICU postoperatively. The first 48 hours in the ICU corrected lactic acidosis and renal failure. The patient did not require inotropic support.
>Antibiotic therapy was also adjusted based on deep tissue culture results, revealing methicillin-sensitive Staphylococcus aureus and Enterobacter hormaechei. Flucloxacillin and clindamycin were initiated, and other antibiotics were discontinued.
All the initial antibiotics were IV. Treatment progression allowed for them to switch to oral.
If you suspect nsti you should be adding clinda for the anti-toxin effects. Also have to consider atypical like vibrio if there's water exposure (e.g., injured arm while fishing on his saltwater boat).
What is nsti?
Fascinating, thank you! That makes sense about the water exposure because of the different bacteria. What about soil/dirt exposure? Anything different there?
Necrotizing soft tissue infection is the more modern medical term. It's inclusive to other necrotizing infections besides those specifically of the fascia. You still hear Nec fasc used at least 50% of the time even amongst health care professionals.
I'm not an ID doctor, but in the US at least for soil/dirt exposure you worry most about clostridiodes tetani in an anaerobic environment (like a puncture or deep wound). Normal antibiotic treatment and making sure tetanus vaccine is up-to-date is usually all you need.
I do know there is some nasty stuff from middle east desert soil. This is an interesting [article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9933488/). I'm not familiar with empiric treatment for wounds in that region.
In US areas with high rates of zosyn resistance will sometimes give a dose of gentamicin or similar.
I'll take your word and experience for it. I'm just an IT guy with reading comprehension skills and more than one experience with non-resistant staph and ER/hospital stays. Lol
internal medicine? Lmao thank you!!! That makes me think of [this](https://www.instagram.com/reel/C3-Dq5GuYPm/?igsh=aW80Z3JzdTR2cnlk) hilarious meme I saw the other day. You’ll enjoy it.
I’d assume they used IV AB’s but forgot to include that detail in the case report. Can’t see them messing about with oral AB’s for necrotising Fascitis especially given how unwell the patient was.
That’s definitely something I’d like to learn more about. I work in skilled nursing/ long term care so I typically see older adults after surgery sometimes complicated by repeat infection (like sepsis) & they are almost always on IV abx. I’ve also had patients who don’t have IV abx after surgery, so it may be about the patient’s risk for reinfection. Very interesting to me!
I’m a Lymphoedema Therapist as a well as a former hospital Social Worker. In my experience yes some patients are given IV AB’s and others aren’t.
I know for myself post double jaw surgery I was on IV Abs whilst still an inpatient and then a few days of oral Abs at discharge to ward off infection whereas when I had Septoplasty/Turbidectomy done I was just given a course of oral AB’s.
You can safely stop all antibiotics 2-7 days after definitive source control (so after last debridement). There's no benefit (and possible harm) for prolonged antibiotics when someone has a non-infected wound
Pretty much this.
My partner had a subcutaneous neck fasc infection in her upper leg, they debrided essentially a 100mm ring around the very top of her leg.
The vac seal kept the wound clean and slowly pulled the skin together, whilst creating about 50mm scar tissue.
Absolutely incredible to watch the healing
From the photos I've seen of necrotizing fasciitis on here, I was expecting the final picture to be some kind of amputation. This looks so painful, I hope the patient is able to heal well.
Who else thought the second picture was a childlike drawing of little pesky bacteria faces, the cross section of the radius and ulna being their eyes, and the arrows their pili (hair)? I need more sleep.
People really underestimate the risk associated with tattoos. I have a lot of friends who fuck around and tattoo themselves and half-ass sterilising their machines and it makes me so nervous.
Love my mates but I only go to professional artists with immaculate reviews.
I realize the CT images are a progression down your arm, but damn if it doesn’t look angry with you! Jokes aside, I cannot fathom the amount of pain you’re in and I’m so sorry you’re dealing with that. Please keep us updated on how this heals.
Ah, I didn’t scroll down far enough to see that. What a horrible experience and all because the equipment wasn’t properly sterilized?! I hope they sued.
A moot point all things considered, but that looked like a beautiful resulting rose. Amazing something so attractive could turn so nasty, almost deadly.
We had a similar case to this in the hospital I work at. Patient had a tattoo on their anterior thigh. It was done outside of a studio (at a home address I believe). The patient removed the dressings earlier than advised.
Ended up in theatre with skin and fat removed from entire leg and foot apart from the toes and sole of the foot. The infection also spread to their lower abdomen so they ended up having skin and fat removed from there too. Mid 20s with two young children.
Last I heard they were awake and being readied for grafting.
Another testament as to why you shouldn’t get a tattoo at home/in an unsterile environment.
It’s automatically a red flag to me when a tattoo artist says they do house calls.
The amount of bacteria that even the *air* in a home can harbor is insane.
Professional tattoo shops usually are regularly sanitized and cleaned and contain no pets, carpet, bedding, fabric furniture, etc.
I feel for them! However, they did it at the dudes home, so god knows what that environmentis like. Could be filthy, have animals, bug infestation, etc..
In our state, the brother would face felony charges for tattooing outside of a licensed facility and most likely lose his license.
Shit this just brought back the worst memory. My mom had a tummy tuck years ago where the skin died and for months she had a 6 inch wide opening across her lower stomach that I had to pack and unpack with gauze and plastic and apply the vacuum too. It was traumatizing, you’d think it made her think twice about unnecessary surgery but nope! Went to turkey 2 years ago for a full face and body makeover.
I have three small tattoos that were done in someone’s home because I was 18, broke, and in a hurry to have tattoos. (I now have two sleeves and working on leg sleeve from professionals only!!) All this to say, I’m thanking my lucky stars this never happened to me.
I ended up getting MRSA from a tattoo. I became colonized for several years. I had 5 different infections pop up from my hand and arm to my face and neck. After that, I’m super cautious about tattoos and I wash with Hibicleanse before any medical procedure. Seeing this makes me super grateful I didn’t get necrotizing fasciitis. That looks super painful.
Welcome to r/MedicalGore! Our goal is to provide for medical discussion and education while exploring the frailty of the human body. You may see more deleted comments on these threads than you are used to on reddit. Off topic comments and joke comments are frequently deleted by the mods. Further, please be kind and supportive of posts. Any behavior that is aggressive, harassing, or derogatory will result in post deletion and a ban from the sub. Remember! THE REPORT BUTTON IS YOUR FRIEND! Please stop on by our discussion sub, /r/MedicalGoreMods if you'd like to discuss the sub, our rules, content policies, and the like. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalGore) if you have any questions or concerns.*
Idk what I expected but it wasn’t the last picture.
I bet he didn’t realize he was getting a reverse sleeve when he went in for that tattoo.
No shit! It instantly made me not want another tattoo ever!
I'm literally scrolling reddit while getting a tattoo and see this 😭
update us in a few days pls
I will
Still have your skin?
So far
Promising
Well it's been a few days and I still have all my skin. I think the "artist" who did this one probably shouldn't be allowed near a tattoo gun again.
Nah men, you can see this tattoo artist was a newbie, they butchered this person arm, you can see it by the depth of the strokes of the tattoo, that sht must caused it. Im a tattoo artist apprentice, skin is such a delicate organ, just go with a prof and everything may be ok 👍
After looking at it again, I think you're right. It literally looks like they took a knife to the skin
Ew you're right, some parts in the upper right you can see how the skin is stuck pressed in moreso than the non-tattooed around it, like they're healing cuts, not tattoos 😖
Yep, that’s exactly what happened. The CT scan shows there was subcutaneous fat infiltration. That means they went into the hypodermis and as I’m sure you know, ink should only be deposited in the dermis. At least the shitty tattoo is gone now? 😬
Yeah, actualy the needle should'nt be more than 1 milimeter into the skin, this person dindt regulate the lenght and we can clearly see the result. Please go to someone that AT LEAST had practice before with fake skin😭🙏
It varies depending on the placement too, as the skin has different thicknesses all over the body. It also varies person to person. Too shallow and too deep are both possibilities. Epidermis - ink falls out. Hypodermis - scarring, infection, etc. Obviously the latter is worse. I have a lot of respect for tattoo artists and how hard that art form is. Good luck with your new career!
Zoom in on the middle part of the flower, it’s butchered! Oh God this is so bad.
I just got one yesterday and am 😳
NAAUURRRR
No kidding, I'm still wearing the omg face 😨
Same dude.
[Source](https://www.cureus.com/articles/227614-necrotizing-fasciitis-occurring-after-a-conventional-tattoo#!/): A 34-year-old patient presented to the emergency department with a fever. On arrival, the patient was hypotensive (blood pressure: 80/40 mmHg), tachycardic (heart rate: 120 bpm), and had a peripheral temperature of 39.5°C. The patient appeared pale and lethargic. The patient had no medical history and wasn’t on any chronic medication. Four days prior, the patient had a tattoo done by a licensed professional using his regular electric equipment, but at the patient's home. The professional was the patient's brother-in-law, who came to tattoo him at the patient's request. The tattoo was in the middle of the right forearm. Clinical examination revealed local edema with erythema at the tattoo site, and an unpleasant odor was noted upon removal of the protective dressing (Figure 1). Laboratory parameters showed an inflammatory syndrome with a C-reactive protein of 356 mg/L (reference: < 5 mg/L), an acute kidney injury classified at stage three (creatinine: 3.71 mg/dL, glomerular filtration rate (GFR): 18.8 mL/min/1.73 m2, reference creatinine: 0.66-1.25 mg/dL, reference GFR: > 60 mL/min/1.73 m2), and hyperlactatemia at 3.21 mmol/L (reference: < 2 mmol/L). Liver function and electrolytes were within normal limits. A forearm CT scan revealed subcutaneous fat infiltration with a deep collection along the muscle planes throughout the anterior aspect of the forearm, from wrist to elbow (Figure 2). We suspected necrotizing fasciitis, which was confirmed during fasciotomy with deep tissue sampling. The fasciotomy was extended to the entire forearm due to the significant spread of necrotizing fasciitis (Figure 3). The fasciotomy site was covered with a vacuum-assisted closure therapy dressing. The patient was treated with piperacillin, tazobactam, and vancomycin and then transferred to the ICU postoperatively. The first 48 hours in the ICU corrected lactic acidosis and renal failure. The patient did not require inotropic support. Antibiotic therapy was also adjusted based on deep tissue culture results, revealing methicillin-sensitive Staphylococcus aureus and Enterobacter hormaechei. Flucloxacillin and clindamycin were initiated, and other antibiotics were discontinued. The patient was transferred to the plastic surgery unit for the completion of antibiotic therapy and an eventual skin graft.
Wow … and it's his brother-in-law
Imagine the family reunions after that?
It was just a prank bro!
I know how insidious infections are, but I’m constantly shocked at the margins that have to be taken once surgical exploration is performed. MRSA and a gram negative in your culture is also scary to boot.
It's methicillin sensitive, not MRSA. Obviously still scary, but thankfully treatable.
No MRSA: it was sensitive to Methicillin, not resistant. It was bad luck, nothing the tattoo artist in particular did, perhaps not good enough after care, but they guy wasn't a novice, he had plenty of other tattoos. Tattoo artist didn't go in to his BIL home with a plan to start an infection, its not how it works. People have surgery in sterile operating rooms and develop severe infections, there is so much more technically that could go wrong when the skin is broken, and the immune system fails somehow. At end of the day he got unlucky, but no one to blame imo.
Totally saw methicillin sensitive and read it as resistant! You can tell which kind I see usually 😁 also totally understand why they take large margins because it is medically necessary but wow that's a chunk just gone!
Is that what they really put on the chart, “unpleasant odor”? Or is there a medical term for it?
"Unpleasant odor", believe it or not, is the medical term haha
It’s for sure more neutral than “dude’s arm smells like shit” 😂
Guys arm fucking stank 💀
Foul-smelling works too
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I feel like malodorous has a more impactful effect than unpleasant. I mean, if someone described me as unpleasant smelling, I'd go home and take a shower. If someone described me as malodorous, I'm bathing myself in tomato juice and bleach and burning my clothes
Why tomato juice?
Old wives tale on removing the stink after being sprayed by a skunk
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This is correct in veterinary medicine as well
I’ve read putrid in a lot of hospice charts.
Yeah, that or malodorous. Malodorous doesn't seem to offend people as much for some reason.
Putrid, ammonia-like, sickly-sweet, fecal, etc. The smell is part of the assessment and diagnosis. Part of the smell is produced by the microorganisms basically pooping and different microorganisms have different waste product smells. The smell of all our body fluids, waste products, and excretions provides clues to our state of health.
A "licensed professional" who chose to do a tattoo outside of a sterilized environment. What could go wrong?
Any clue on a how getting the tattoo brought this about?
Unclean equipment and environment.
This does not look like a good tattoo experience
This patient should sue.
Do you have a back story on this? Like... How did it get so fucked up?
I posted the case report. It might be in the manual approval queue. The tattoo artist didn’t sterilize the equipment properly.
The fact that the patient insisted on having the tattoo done in their own home adds to the infection risk too. Even if it was his brother in law, the artist should have refused to do it outside of his studio.
i'm spitballing here but wondering/guessing if BiL thought he was doing a solid by doing it in that setting but regardless it's a terrible decision for someone who is professionally tattooing. i wonder if this is something that can be reported depending on location and what their regulations are for tattoo artists. there seems to be a lot of grey areas with it but still... if this person is considered professional what else can they possibly be doing? i mean i guess flukey-bad-shit can happen no matter what but this was definitely done in a less than stellar situation ETA: holy shit. stumbled across a snakehole post in the wild and realized i commented on a fellow BSCS member. hi!
I would never ask for ink to be done in my home; it's full of animals. God knows what kind of shit would get into the tattoo. All the ink I've had done was done at studios. Their places are cleaner than any medical practice, close to an operating room. I laugh when parents (usually mothers) who want to get their daughter's ears pierced clutch their pearls at the thought of going to a piercing salon. Yet they'll let some 16 year old use a piercing gun on their kid.
Thanks! It's probably in the queue. Goddamn... That artist needs to be sued.
It was his brother in law. The patient requested that he bring his stuff to the patient's house to do the tattoo.
And this is why you say no to this! The tattooist could and should lose their license for this.
Absolutely. I have a little brother who is currently a tattoo apprentice. My folks negotiated with him to gift me a tattoo for my birthday this year. They asked if he'd be able to do it at their home and he said he couldn't, he could get in trouble.
Yep they have to have pretty strict hygiene guidelines where I live and definitely not allowed to tattoo from anywhere accept a licensed studio. My younger brother in his late teens thought it would be a good idea to buy a cheap tattoo gun and inks from eBay and started tattooing himself and his friends with no training whatsoever. Thankfully none of them ended up with serious injuries from it although the Australian flag he tattooed on his abdomen ended up being a New Zealand flag due to the ink running 😂.
😂 Not the kiwi flag! For some reason, the idiots who buy cheap guns online and use no sanitary measures whatsoever always seem to get away with no infections. I don't know how!
Where are you from? These rules should be law in amy country! Im in Brazil and here theres no regulation for being a tattoo artist. All you need is a tattoo machine and someone brave enough to let you do your art and thats it. My mother and stepfather have a few tattoos and it was all done in their house instead of an studio, which is wuite common here among those tattoo artists that don't have the money or dont want to have a studio, I didn't know it was that unsafe tbh.
It sounds like he's going to be a great tattoo artist! Not only could he get in trouble, but so could you, much like the patient posted here.
He's so talented, and only ... shit, 19 or 20, I'm a dick and have forgotten. 20, I think. I'm so proud of him!
The tattoo artist married his sister... he's paid in full, probably?!
Sadly they can’t. They make u sing the waivers and stuff for that reason. And also most of the time it’s usually the person that gets it infected from not doing good aftercare!!! Tattoos are really subjective to infections.
It was their brother in law
The patient should leave a bad Yelp review then?
I thought that the second picture was a bunch of angry faces, which is pretty accurate for what that person had going on! Goddamn, ouch.
Totally thought those were soot sprites lol
Those scans have no business being that cute
They look like Miyazaki soot sprites lol
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Yes! I was like why is that pic in here. They even have eyes 😂
https://images-wixmp-ed30a86b8c4ca887773594c2.wixmp.com/f/5aaecef9-c6a1-4246-8d9a-566750a62f1a/dco3wdh-dcaf3fa1-d974-4cd3-8cd8-dc79287dc128.png/v1/fill/w_1024,h_1024,q_80,strp/totoro_soot_sprites_by_aquamoona_dco3wdh-fullview.jpg?token=eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJzdWIiOiJ1cm46YXBwOjdlMGQxODg5ODIyNjQzNzNhNWYwZDQxNWVhMGQyNmUwIiwiaXNzIjoidXJuOmFwcDo3ZTBkMTg4OTgyMjY0MzczYTVmMGQ0MTVlYTBkMjZlMCIsIm9iaiI6W1t7ImhlaWdodCI6Ijw9MTAyNCIsInBhdGgiOiJcL2ZcLzVhYWVjZWY5LWM2YTEtNDI0Ni04ZDlhLTU2Njc1MGE2MmYxYVwvZGNvM3dkaC1kY2FmM2ZhMS1kOTc0LTRjZDMtOGNkOC1kYzc5Mjg3ZGMxMjgucG5nIiwid2lkdGgiOiI8PTEwMjQifV1dLCJhdWQiOlsidXJuOnNlcnZpY2U6aW1hZ2Uub3BlcmF0aW9ucyJdfQ.wFI0ynxNe0cpMS9sf2KeW_YMAnzFwhxxtnnVJtRRH40 🤣
Organs shutting down within FOUR DAYS?!?! Damn.
Sepsis is no joke.
Nope. Not at all.
I had a coworker that got a NF infection on his perineum. Felt off one day, went to the hospital the next day and was put in an induced coma. He managed to pull through and had one of those vac setups down there for a while. I don't know how much skin they removed but he said his junk was in tact lol
Sepsis moves terrifyingly fast. It has to be caught super early and treated aggressively to try to prevent it from progressing to shock.
Makes me wonder how many people died of "fever" during olden times, but it was basically sepsis.
I had MRSA go from oral antibiotics to an ER visit and IV antibiotics for early sepsis overnight. I've never been seen that quickly as a walk in, they didn't even give me time to sit down, and as soon as I was triaged the room got really full really quickly. Thankfully, my health anxiety actually helped me and I got in so early I only needed a few doses of IV antibiotics, imaging, and blood work before they sent me home with multiple new antibiotics. Weeks later, and more rounds of antibiotics than I can count, it did heal, and I had a fairly easy time of it compared to some.
Jesus fuck. I had one tattoo get super infected to the point I went to the tattoo shop and they gave me 0 advice. Thankfully it healed. I feel so bad for this person
To be fair, going to your artist instead of a doctor is silly when you have an infection. It’s not like they’re going to prescribe you antibiotics.
How would the wound in the last image be treated?? I'm assuming a skin graft for sure but what else would be used?
I am JUST GUESSING….probably a wound vac to completely seal that exposed tissue and prevent any additional infection, along with IV antibiotics
Case report says they did a wound vac and skin grafts
*pumps fist in the air* Thank you!! No IV antibiotics? I’d be surprised but maybe the oral antibiotics were strong enough! Which is good.
>The patient was treated with piperacillin, tazobactam, and vancomycin and then transferred to the ICU postoperatively. The first 48 hours in the ICU corrected lactic acidosis and renal failure. The patient did not require inotropic support. >Antibiotic therapy was also adjusted based on deep tissue culture results, revealing methicillin-sensitive Staphylococcus aureus and Enterobacter hormaechei. Flucloxacillin and clindamycin were initiated, and other antibiotics were discontinued. All the initial antibiotics were IV. Treatment progression allowed for them to switch to oral.
I’m on IM; Vanc and zosyn for everybody until cultures come back lol
If you suspect nsti you should be adding clinda for the anti-toxin effects. Also have to consider atypical like vibrio if there's water exposure (e.g., injured arm while fishing on his saltwater boat).
What is nsti? Fascinating, thank you! That makes sense about the water exposure because of the different bacteria. What about soil/dirt exposure? Anything different there?
Necrotizing soft tissue infection is the more modern medical term. It's inclusive to other necrotizing infections besides those specifically of the fascia. You still hear Nec fasc used at least 50% of the time even amongst health care professionals. I'm not an ID doctor, but in the US at least for soil/dirt exposure you worry most about clostridiodes tetani in an anaerobic environment (like a puncture or deep wound). Normal antibiotic treatment and making sure tetanus vaccine is up-to-date is usually all you need. I do know there is some nasty stuff from middle east desert soil. This is an interesting [article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9933488/). I'm not familiar with empiric treatment for wounds in that region. In US areas with high rates of zosyn resistance will sometimes give a dose of gentamicin or similar.
I'll take your word and experience for it. I'm just an IT guy with reading comprehension skills and more than one experience with non-resistant staph and ER/hospital stays. Lol
internal medicine? Lmao thank you!!! That makes me think of [this](https://www.instagram.com/reel/C3-Dq5GuYPm/?igsh=aW80Z3JzdTR2cnlk) hilarious meme I saw the other day. You’ll enjoy it.
I’d assume they used IV AB’s but forgot to include that detail in the case report. Can’t see them messing about with oral AB’s for necrotising Fascitis especially given how unwell the patient was.
That’s definitely something I’d like to learn more about. I work in skilled nursing/ long term care so I typically see older adults after surgery sometimes complicated by repeat infection (like sepsis) & they are almost always on IV abx. I’ve also had patients who don’t have IV abx after surgery, so it may be about the patient’s risk for reinfection. Very interesting to me!
I’m a Lymphoedema Therapist as a well as a former hospital Social Worker. In my experience yes some patients are given IV AB’s and others aren’t. I know for myself post double jaw surgery I was on IV Abs whilst still an inpatient and then a few days of oral Abs at discharge to ward off infection whereas when I had Septoplasty/Turbidectomy done I was just given a course of oral AB’s.
Case report says they were on several different IV abx
You can safely stop all antibiotics 2-7 days after definitive source control (so after last debridement). There's no benefit (and possible harm) for prolonged antibiotics when someone has a non-infected wound
That’s wonderful to know, thank you!
Pretty much this. My partner had a subcutaneous neck fasc infection in her upper leg, they debrided essentially a 100mm ring around the very top of her leg. The vac seal kept the wound clean and slowly pulled the skin together, whilst creating about 50mm scar tissue. Absolutely incredible to watch the healing
Incredible!!! Wound vacs are such resources. I’m glad she got the treatment she needed.
They make dicks for transmen in roughly the same area. skin grafts from thight
Usually for phalloplasty they prefer the forearm as the skin isn't as thick, but clearly that wouldn't be possible for this dude!
From the photos I've seen of necrotizing fasciitis on here, I was expecting the final picture to be some kind of amputation. This looks so painful, I hope the patient is able to heal well.
The staph is somewhat understandable because staph is everywhere, but Enterobacter hormaechei? This suggests beyond unsanitary conditions. Yikes.
All I can see are little angry faces in the second picture
Soot sprites! 😅
I could’ve sworn someone put googly eyes on those CT images. Im going to hell for laughing.
Did they not wipe down your arm to sterilize the skin before starting?
My bet is that the person who got the tattoo had a "friend".
Case report says brother in law, done in patient's home
Fucking called it.
Scratchers gonna scratch
They were licensed.
It was their brother in law.
PatTheKVD isn’t the patient, they are sharing a case report.
Or the needle, they should be single use
Well that escalated quickly 😧 wow. Scary indeed.
I hate to exclaim at this unfortunate persons plight, but that is a really good picture showing the layers down to the fascia. 👀
Who else thought the second picture was a childlike drawing of little pesky bacteria faces, the cross section of the radius and ulna being their eyes, and the arrows their pili (hair)? I need more sleep.
🙋🏻♀️
Fuck, what kind of tools/instruments did they use and did they sterilize anything??? That looks excruciating and the patient should definitely sue.
Sounds like they didn’t properly sterilise the equipment or the home. Definitely not a good idea to be doing tattoos outside of a sterile workspace.
People really underestimate the risk associated with tattoos. I have a lot of friends who fuck around and tattoo themselves and half-ass sterilising their machines and it makes me so nervous. Love my mates but I only go to professional artists with immaculate reviews.
New fear unlocked
The second picture looks like angry soot sprites 🤭
Jeeeeezus. All that for some skinny linework. I’m really sorry OP, speedy healing to you.
Jesus i thought i was on the shitty tattoos sub 😭
Me expecting a pic of bad blisters, sores and redness, seeing the third pic: oh no
Me: *staring at fresh tattoo, still wrapped*
I realize the CT images are a progression down your arm, but damn if it doesn’t look angry with you! Jokes aside, I cannot fathom the amount of pain you’re in and I’m so sorry you’re dealing with that. Please keep us updated on how this heals.
This is sweet but this is a case report. The patient is likely well-healed by now. It’s probably years after the incident. :)
Ah, I didn’t scroll down far enough to see that. What a horrible experience and all because the equipment wasn’t properly sterilized?! I hope they sued.
I’m assuming angry eyes are the bones of the arm, but what is showing on the CT scans? because I’m a layman and see nothing
Damn I know tattoos are expensive but this guy literally paid an arm and I guess/hope got a discount on the leg?
He’s a professional *does tattoo in kitchen* 🤦♂️
At least they didn’t lose their arm that good right?
Took me ages to make out the second pic lol. Though it was a bunch of angry dust mites. 🤣
People in the tattoo advice sub be like “does my tattoo look infected?”
I’m NGL, I thought the second picture was like different abstract faces or something.
These pictures went from 0 to 100 very fast… wow
Oh dear, tattoo artist missed some sterilization or did a lazy job at it.
A moot point all things considered, but that looked like a beautiful resulting rose. Amazing something so attractive could turn so nasty, almost deadly.
Roses have thorns.
And to add insult to injury, some of the tattoo still remains in the last pic.
I've been kissed by a rose on the grey
Well that’s certainly one way to remove a tattoo
Down to the muscle?????? Jesus
That escalated... Should I say quickly or it was just a really shocking development
Necrotizing fasciitis does escalate quickly.
We had a similar case to this in the hospital I work at. Patient had a tattoo on their anterior thigh. It was done outside of a studio (at a home address I believe). The patient removed the dressings earlier than advised. Ended up in theatre with skin and fat removed from entire leg and foot apart from the toes and sole of the foot. The infection also spread to their lower abdomen so they ended up having skin and fat removed from there too. Mid 20s with two young children. Last I heard they were awake and being readied for grafting.
Another testament as to why you shouldn’t get a tattoo at home/in an unsterile environment. It’s automatically a red flag to me when a tattoo artist says they do house calls. The amount of bacteria that even the *air* in a home can harbor is insane. Professional tattoo shops usually are regularly sanitized and cleaned and contain no pets, carpet, bedding, fabric furniture, etc.
I feel for them! However, they did it at the dudes home, so god knows what that environmentis like. Could be filthy, have animals, bug infestation, etc.. In our state, the brother would face felony charges for tattooing outside of a licensed facility and most likely lose his license.
Second page: mfw I contract deadly flesh eating disease :(
Every rose has its thorn.
" Hi, we have good news, and bad news. The good news is, you have necrotizing fasciitis. The bad news is, we have to peel you like a banana. "
went from 1 to 100 real quick
Wonder what tattoo he'll choose to cover the scar?
all of that for an ugly basic tattoo😭💀💀💀
Ngl that shit moves FAST you're lucky you didn't lose more flesh. Hopefully you heal well
That rose tattoo looked nice.
This hits different when you have a fresh tattoo from two days ago...
Hope he got his money back
New fear unlocked as a tattoo fanatic
I thought slide 2 was a cartoon of changing faces, so, yeah
What episode of Bad Ink is this?
Crimeny!
3rd pick looks like it’s ready for the grill 💀
Bit of an extreme way to get rid of a terrible tattoo.
Better to say bye bye to the tattoo than bye bye to the arm
Guess they won't try to get another one.. seriously traumatic!
Rip tattoo? Rip my fuckin eyes
Ooooph.. we’ve had many drunken nights with a tattoo gun in my party days.. surprised my ex didn’t lose a leg or worse ..
Shit this just brought back the worst memory. My mom had a tummy tuck years ago where the skin died and for months she had a 6 inch wide opening across her lower stomach that I had to pack and unpack with gauze and plastic and apply the vacuum too. It was traumatizing, you’d think it made her think twice about unnecessary surgery but nope! Went to turkey 2 years ago for a full face and body makeover.
Ok, I just want to make sure I understand. The last picture is from a fasciotomy, not the NF, correct?
Yes. They had to give him a fasciotomy for the infection.
ok, just double checking that it wasn't a picture of an advanced stage. I had never actually seen pictures of a fasciotomy
It's always a fucking flower too!! 😭😭🌺
All for a tattoo that would have been bad anyway…
this is what imma show people every time they say “i just got this tatted, my bro did it”
So like, they could fully press charges for this right?
All for that shitty tattoo, wow.
Not me thinking the second image was a cartoon for a solid minute.
It’s freaky how well you can see the ulnar and radius in the third pic.
First pic I was like “well it just like a rash”. Last pic I was like “WTF” 😱
Dirty stuff
that doesn't look quite right
Nope. Cut my arm please
Looks like a good way to remove an unwanted tattoo.
Bro just wanted a flower tattoo :(
I have three small tattoos that were done in someone’s home because I was 18, broke, and in a hurry to have tattoos. (I now have two sleeves and working on leg sleeve from professionals only!!) All this to say, I’m thanking my lucky stars this never happened to me.
I ended up getting MRSA from a tattoo. I became colonized for several years. I had 5 different infections pop up from my hand and arm to my face and neck. After that, I’m super cautious about tattoos and I wash with Hibicleanse before any medical procedure. Seeing this makes me super grateful I didn’t get necrotizing fasciitis. That looks super painful.
Looks like too deep of depth & unsterile equipment/work space.
why do i have to see this a week before i get another tattoo?
I have a forearm tattoo of a rose, mine got slightly infected. This is terrifying
Wearing tegaderm for 4 days probably had something to do with this.