Periauricular and auricular necrotising wound in 5-year-old boy with soft-tissue cellulitis of the lower ear auricle and adjacent neck soft tissue after being bit by a brown recluse spider.
A 5-year-old boy presented to the emergency with soft-tissue cellulitis of the lower ear auricle and adjacent neck soft tissue because of a brown recluse spider bite. The wound was initially managed with debridement and intravenous antibiotics. Similarly, on the 12th day, the plastic surgery service was consulted and the wound was debrided again. In addition, the wound was cultured and showed growth of methicillin-resistant Staphylococcus aureus sensitive to vancomycin and trimethaprim/sulfamethoxazole.
The patient was immediately started on negative pressure wound therapy a day after debridement. Moreover, polyurethane was used as a wound filler, whereas, nanocrystalline silver mesh was used as a contact layer without the absorbent layer.
However, the NPWT dressing was placed over the entire auricle because of difficulty in maintaining a vacuum seal. A Xeroform gauze was used for dressing the external auditory canal. Moreover, it was daily irrigated with sterile water. Both for promoting exudate clearance and for activating the silver in the dressing. The polyurethane foam was directly placed adjacent to the canal over the occlusive dressing. The interface pressure of the wound was measured to be -80 mm Hg.
The patient was called in for the dressing to be changed and debrided after every 3 to 5 days. Similarly, the bed of the wound was fully granulated 20 days after the initial debridement, requiring a total of 7 days of NPWT. The wound was closed with a split-thickness graft.
Fortunately, the patient had an uneventful recovery. Moreover, 14 months after the surgery, the patient underwent a first-stage reconstruction of the ear lobule. Likewise, a complete sulcus restoration and removal of more split-thickness graft after a month.
CASE REPORT Management of Periauricular and Auricular Necrotizing Wound From Brown Recluse Spider Bite Using Negative Pressure Wound Therapy and Wound Interface Modulation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370922/