Management of a Large Necrotic Abdominal Wall Ulcer Following Repeated Insulin Injections in a Patient with Diabetes Mellitus: A Case Report
DOI:
https://doi.org/10.65495/eurjimr.2026.12Keywords:
diabetic wound, insulin injection site, abdominal wall necrosis, negative pressure wound therapy, split-thickness skin graftAbstract
Background: Large abdominal wall ulcers resulting from repeated insulin injections are exceptionally uncommon, with only isolated reports describing progressive soft-tissue necrosis arising from chronic injection-related microtrauma. Diabetic patients are particularly vulnerable to such complications due to underlying microangiopathy, impaired immunity, neuropathy, and diminished tissue resilience. This case is reported to highlight an unusual presentation of progressive abdominal wall necrosis in a long-standing insulin-dependent diabetic patient and to emphasize key principles of assessment and management.
Case Presentation: A 69-year-old woman with long-standing type 2 diabetes mellitus presented with a progressively enlarging ulcer in the left upper abdominal quadrant, initially developing at a habitual insulin injection site. Examination revealed a large necrotic defect with extensive subcutaneous tissue loss but preserved fascial integrity. Laboratory evaluation showed hyperglycemia without systemic inflammatory response. Imaging and intraoperative assessment did not support necrotizing fasciitis. The patient underwent staged surgical debridement followed by negative pressure wound therapy to optimize the wound bed. Once robust granulation developed, definitive coverage was achieved with a split-thickness skin graft, resulting in complete graft take and uneventful recovery.
Conclusions: This case underscores the potential for repeated insulin injections to precipitate extensive soft-tissue injury in diabetic patients, even in the absence of overt infection or necrotizing fasciitis. Early recognition, meticulous debridement, and timely initiation of negative pressure wound therapy are essential to preventing disease progression and enabling successful reconstruction. Clinicians should maintain a high index of suspicion for injection-site complications and reinforce preventive education on rotation techniques and site inspection in vulnerable patients.
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Copyright (c) 2026 Fatih Şahin (Author)
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