[Foot defect with vascular and neural injury due to freshwater stingray sting: reconstruction with a lesser saphenous vein adipo-fascial flap].
The emergency care to stingrays envenomation permits, in the majority of cases, to limit the damage caused. In the case of delayed medical care, we can meet deep and extensive lesions that need to be thoroughly explored in order to better address their reconstruction. We report the case of a patient injured by freshwater stingray. He presented a necrotic defect of 6 cm in diameter under the right medial malleolus with bone exposure and neurovascular injury. We opted for a therapeutic strategy in two steps. The first step consisted in a large debridement of the necrotic defect, under appropriate antibiotics and negative pressure therapy. Three weeks later, we covered the defect with a distally based lesser saphenous vein veno-fascia-subcutaneous flap, covered with a split-thickness graft. The coverage of the defect was satisfactory. The infection was controlled with antibiotics, which we prolonged for one month. The patient presented, initially, hypoesthesia of the upper lateral foot in relation with a neurapraxis of the sural nerve. The symptoms resolved at two months. The foot edema due to venous stasis also resolved at two months. The donor site healed without complications. The ability to wear normal shoes was preserved. The patient resumed his daily activities promptly.
Moutran
M
M
Service de chirurgie plastique reconstructrice et esthétique, hôpital Edouard-Herriot, pavillon U2B, place d'Arsonval, 69003 Lyon, France. michelmoutran@yahoo.fr
Mojallal
A
A
Chekaroua
K
K
Martin
E
E
Braye
F
F
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001733:Bites and Stings / Q000150:complications*; D003646:Debridement; D005397:Fish Venoms / Q000506:poisoning*; D005400:Fishes, Poisonous; D018409:Foot Injuries / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D005618:Fresh Water; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010146:Pain / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000601:surgery; D012501:Saphenous Vein / Q000637:transplantation*; D013497:Sural Nerve / Q000293:injuries; D013524:Surgical Flaps; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005397:Fish Venoms