Medicaltalks
Medicaltalks
in General
Spiders bite
Spiders bite
This is why many peoples’ nightmares contain spiders. An extreme case showing brown recluse spider bite of the thumb! 🕷 The top left image was taken 3 days after the bite, and presented is progressive redness as well as tissue destruction. The top right image is at 6 days after the incident. In the bottom image, 9 days after being bitten, this patient is suffering from severe tissue destruction due to the venom of the brown recluse spider. This person got bitten by a spider, but little did he know that it had been a brown recluse spider, whose venom is known to destroy cartilage, as well as soft tissue and skin. These spiders are generally not violent and bite only when threatened, generally when pushed up against the aggressor’s skin. The brown recluse venom can destroy human tissue. The victim may not feel or notice the bite when it occurs. At first, the bite site may appear like any other insect bite - a little red, itchy and inflamed. Over the course of a few days, the venom destroys the surrounding tissues. The wound gets larger, more painful, and darker in color. Necrosis (tissue death) is identified when the tissue becomes black in color and forms a crust that eventually falls off. The venom can penetrate deeper in the tissues, sometimes affecting the fat and muscles. The wound formed from the venom can quickly and easily allow an infection to set in, worsening the wound-healing process. Leaving it untreated, allowed the venom to cause this lesion. This venom contains a rare protein that can cause a lesion, or a much less common, but more dangerous, systemic reaction in humans, depends on the amount of venom injected. The most common response is inflammation that after one to two days can develop into a "dark lesion" surrounding the bite site. The blackening, or necrosis, of the skin is dead skin cells, evidence of the immune system's efforts to prevent spread of the toxin by preventing blood flow to the affected area. It can be also dry, blue-gray or blue-white, with an irregular sinking patch with torn edges and extremely swollen and red with the open wound ranging anywhere from a few centimeters to a few inches in size.
Vincent Lee
Vincent Lee
in Articles
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What would you do?
Vincent Lee
Vincent Lee
in Case Study
Squamous cell carcinoma
Squamous cell carcinoma
This is a huge squamous cell carcinoma (T4) in the head, grown over 5 years until this patient sought help. He was treated initially with a huge Orticochea Multi-Flap and after sent for chemo and radiation therapy. Cutaneous squamous cell carcinoma (SCC) represents 20 % of all non-melanoma skin cancer and is a deadly threat owing to its ability to metastasize to any organ in the body. High-risk features are depth of invasion (>2 mm), poor histological differentiation, high-risk anatomic location (face, ear, pre/post auricular, genitalia, hands, and feet), perineural involvement, recurrence, multiple SCC tumors, and immunosuppression. Metastatic SCC has a mortality rate of >70 %. Treatment options include surgery, radiation therapy, chemotherapy (cisplatin), and any combination of the above. Surgery alone can be used for metastatic of high-risk SCC treatment but is not as effective as surgery in conjunction with radiation therapy. NCCN guidelines recommend 4-to 6-mm clinical margins for standard excision of low-risk SCC and 6 to 10mm in high-risk, like in this case. In this patient, the resection was made with a 10mm margin, the resection was full-thickness (up to the periosteum), and in the central part, the outer table of the skull was resected. To cover this defect, a big Orticochea flap was made. The Orticochea flap is an excellent option for scalp reconstruction as it decreases operative time may provide hair-bearing skin. After the surgery, the patient was sent to receive chemo and radiation.
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