Self-induced subcutaneous air mimicking a gas-forming infection

We describe three cases of self-induced soft-tissue gas among inmates at a prison. This behavior was specifically designed to gain hospitalization and relied on the simulation of a necrotizing soft-tissue infection. Two cases were treated by surgical exploration only. The third case was treated non-surgically after the etiology was suspected. The possibility of self-induced injury or manufactured physical signs is high in the prison population, and the presence of isolated physical signs or symptoms should be cause for suspicion. The inmates in these cases used manufactured signs and professed symptoms to extract themselves successfully from a prison environment.