Nested graft for chronic ulcer in scar tissue after heroin extravasation in a drug addict

J Tissue Viability. 2021 Feb;30(1):121-123. doi: 10.1016/j.jtv.2020.12.001. Epub 2020 Dec 24.


Introduction: Nested graft is a surgical technique that allows to manage difficult-to-treat medical conditions such as chronic cutaneous ulcers, thanks to the high efficacy it has in reverting the fibroblasts senescence. Because of its peculiar regenerative property, nested graft is a surgical technique suitable also for the treatment of cutaneous ulcers developing on fibrotic scar tissue.

Case report: We reported the case of a 45-year-old man, drug-addict, with a large ulcer on the back of the right forearm in the context of scar fibrotic tissue. This lesion resulted from a previous heroin extravasation treated with a dermo-epidermal skin graft, that was accidentally scratched away by mechanical trauma. After several therapeutic failures with topical medications, we decided to treat the ulcer performing a skin graft using the nested graft technique. No adverse events were reported by the patient during or after the surgery. At the clinical evaluation performed three years later the wound was completely healed.

Conclusions: Nested graft represents a safe and easy-to-use technique that can be successfully used to treat ulcers on scar tissue, ensuring the achievement and the long-term maintenance of optimal resistance and aesthetic results.

Keywords: Chronic ulcer; Heroin extravasation; Nested graft; Scar tissue; Tissue regeneration.

MeSH terms

  • Chronic Disease / rehabilitation
  • Chronic Disease / therapy
  • Cicatrix / surgery*
  • Heroin / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Pressure Ulcer / physiopathology
  • Pressure Ulcer / surgery*
  • Skin Transplantation / methods*
  • Skin Transplantation / rehabilitation
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / physiopathology
  • Wounds and Injuries / etiology*


  • Heroin