Stingray injury of the hand: review of management

Stingray injury to the webspace of the foot

Stingrays are cartilaginous fish that are related to sharks. They are one of the largest groups of venomous marine animals. Stingrays account for 750 to 2000 injuries annually. They are generally passive, reclusive creatures that only sting in self-defense. Most injuries caused by these animals are nonfatal. A stingray possesses between 1 and 4 venomous stings, which are located along the caudal spine. If a stingray injury is sustained, parts of the spine may be left in the lacerations, which prolongs exposure to venom and increases the risk of subsequent wound infection. Stingray venom is unique in its enzymatic composition and results in distinct soft tissue injury patterns. Typically, a pattern of acute inflammation occurs, with a predominantly lymphoid cellular infiltrate followed by necrosis. The environment in which stingray injuries occur presents unique bacterial flora, and subsequent wound infections require careful antibiotic selection.This article describes a case of a healthy 31-year-old woman who sustained a stingray injury to the webspace of the foot while in Costa Rica. Initial basic first aid measures were applied. However, the wound subsequently became infected, and formal irrigation and debridement were performed. The initial wound cultures grew Staphylococcus viridans. Two months postoperatively, the incision was well healed, and the patient was pain free and returned to work.

Prise en charge chirurgicale des plaies par raie. À propos de deux cas

Fifty injuries by stingrays are annually examined in the New Caledonia hospital. The injuries occur most often in the lower extremity, rare puncture injuries to the thorax or abdomen can cause death. The wound is associated with envenomation. The pain is intense with oedema, cyanosis, erythema often followed by tissue necrosis. In many cases, the management of stingray wounds is inadequate and the gravity often not well appreciated. Localized morbidity and prolonged healing may occur without an effective surgical management. Wound exploration and debridement are particularly indicated after first-aid measures, such as immersion in hot water. The characteristics, treatment and prevention are discussed in connection with two cases.