Management of skin necrosis and wound dehiscence following brown recluse spider bite in the course of breast reconstruction: A case report

TL;DR

A patient with a reconstructed breast experienced severe complications from a brown recluse spider bite, requiring surgical intervention and highlighting the challenges of such rare cases.

Contribution

This case report presents a rare complication of breast reconstruction caused by a brown recluse spider bite and its management.

Findings

A brown recluse spider bite led to skin necrosis and wound dehiscence in a breast reconstruction site.

The patient required implant removal and latissimus flap reconstruction to address the complications.

The case emphasizes the importance of considering unusual causes of necrosis in post-reconstruction patients.

Abstract

Breast reconstruction following mastectomy is a critical component of breast cancer treatment, aimed at improving patient quality of life. However, the management is fraught with potential complications, including skin necrosis and wound dehiscence, which can significantly impact clinical outcomes.

We report a unique case of a patient, 5 years post-breast reconstruction following mastectomy and radiation therapy, who developed severe skin necrosis and wound dehiscence due to a brown recluse spider bite on the reconstructed breast. The complication necessitated the debridement of skin, removal of the implant, and further reconstruction with a latissimus flap.

The case underscores the unusual etiology of spider bite-induced necrosis in breast reconstruction and highlights the challenges and strategic considerations in managing such complications. Upon presentation, the patient's affected breast area showed signs of extensive necrosis and wound dehiscence, directly attributed to the cytotoxic effects of the brown recluse spider's venom. The venom's pathophysiology involves a complex cascade, leading to local and systemic effects. The local effects, marked by dermonecrosis, com- promised skin integrity in this instance. Systemic effects, not observed in this patient but potentially severe, can include hemolysis, coagulopathy, and acute renal failure, highlighting the seriousness of brown recluse spider bites.

In conclusion, this case illustrates the complexities of managing breast reconstruction post-mastectomy complications, particularly those caused by external factors such as brown recluse spider bites. It highlights the need for meticulous attention to unusual etiologies of necrosis and dehiscence, demonstrating the importance of adaptable surgical strategies and a thorough understanding of venom pathophysiology in ensuring successful patient outcomes.

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