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Conservative Reconstruction of the Lower Limb with a Bilayer Porous Collagen Matrix after a Spider Bite
Marco Palmesano1, Davide Johan Bottini, Gabriele Storti
1Marco Palmesano, MD, is Plastic Reconstructive and Aesthetic Surgeon, PhD Program in Applied Medical Surgical Sciences, University of Rome Tor Vergata, Rome, Italy. Davide Johan Bottini, MD, PhD, is Consultant in Maxillofacial Surgery, Policlinico Casilino Hospital, Rome. Also at University of Rome Tor Vergata, Gabriele Storti, MD, is Researcher and Consultant in Plastic Surgery; Lorenzo Secondi, MD, is Plastic Reconstructive and Aesthetic Surgeon, PhD Program in Applied Medical Surgical Sciences; and Carlo Cossi, MD; Alessio Calicchia, MD; Martina Giacalone, MD; and Irene Nunziata, MD, are Plastic Surgery Residents. Emanuela Basile, MD, is Consultant in Maxillofacial Surgery, Policlinico Casilino Hospital. Valerio Cervelli, MD, is Full Professor and Chief, Department of Plastic Surgery, University of Rome Tor Vergata. The authors have disclosed no financial relationships related to this article. Submitted January 24, 2024; accepted in revised form March 22, 2024.
Abstract:
Brown recluse spider bites may cause symptoms ranging from local cutaneous reactions to systemic visceral loxoscelism. Most bites are self-limiting, but some can lead to necrotic ulcerations with severe complications and soft tissue defects. Necrotizing ulcers are uncommon and have various clinical presentations, so no standard treatment exists. A 68-year-old man required medical attention after getting a spider bite while traveling in Tanzania. After returning to Italy, the patient presented with a posterior lower limb black papule, local edema, and fever. The lesion quickly ulcerated with an eschar. Medical history and symptoms suggested a brown recluse spider bite. Ulcer management was conservative, with careful surgical debridement and a two-step reconstruction using a split-thickness skin graft and a bilayer porous collagen matrix. Treatment resulted in functional recovery and acceptable aesthetics.
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