The Black Locust Tree: Toxalbumin-Induced Tissue Necrosis of the Upper Extremity.

We present the case of a 48-year-old male who developed tissue necrosis and subsequent necrotizing fasciitis in his right upper extremity after sustaining a puncture injury from a large black locust tree (Robinia pseudoacacia) splinter. Blood and intraoperative wound cultures revealed Streptococcus constellatus and Eikenella corrodens infection. The treatment consisted of IV antibiotics, fasciotomy, and multiple debridements, which left a 30 x 5-cm defect, requiring negative pressure wound therapy with Integra Dermal Regeneration Template (Integra Lifesciences, Plainsboro Township, NJ) and, ultimately, split-thickness skin grafts. Although uncommon, plastic surgeons should be aware of tissue necrosis associated with robin toxalbumin in cases of black locust tree puncture wounds. Robin toxalbumin causes cellular death by inhibiting protein synthesis. In this patient, the toxalbumin from the black locust tree fragment led to extensive tissue necrosis, serving as the nidus for necrotizing fasciitis.