Rapid aggressive soft-tissue necrosis after beetle bite can be treated by radical necrectomy and vacuum...

The substance cantharidin, which is produced by a type of beetle, rapidly penetrates the epidermis and can cause severe toxicities such as skin necrosis. Optimal treatment for necrotic beetle bites has not been well defined. Conservative management has been advocated but the hospital stays are long and long-term morbidity may result, especially in multimorbid patients.

The value of aggressive surgical management of such necrotizing diseases using newly developed surgical tools is compared to the traditional more conservative approach.

We present the case of a multimorbid 60-year-old man with a rapidly progressive necrosis of the medial thigh (measuring 30 X 15 cm), acquired during a stay in Western Africa after being bitten by a beetle of the species Cantharide. The patient was treated with radical surgical debridement and continuous elimination of the wound fluid by permanent computer-controlled negative pressure with a vacuum-assisted wound-closure device. This led to the sudden relief of both local and systemic symptoms and allowed extremely early wound closure.

Comparing literature data with the course of this combined treatment, we strongly suggest an early aggressive management with complete radical excision of necrotic tissue, conditioning of the wound bed by temporary suction-assisted vacuum closure and subsequent skin grafting with continued vacuum application. This treatment leads to immediate relief of pain and enhanced healing of this lesion even in the condition of immunosuppression in the elderly.