# Holistic Therapy in a Patient with Necrotic Ulcer Caused by the Bite of Brazilian Wandering Spider: A Case Report of Challenging Treatment with Combined Therapies

## TL;DR

A 61-year-old man with a severe wound from a Brazilian spider bite was successfully treated using a combination of surgical and advanced therapies.

## Contribution

This case report demonstrates the effectiveness of a combined, individualized treatment approach for a rare, hard-to-heal wound caused by a Phoneutria spider bite.

## Key findings

- Complete wound closure was achieved after 4 months of specialized therapy.
- A multimodal treatment including surgical necrosectomy, grafting, and hyperbaric oxygen therapy was effective.
- Serial microperfusion measurements and photographic documentation aided in monitoring treatment progress.

## Abstract

Hard-to-heal wounds remain a significant challenge for healthcare professionals, particularly in aging populations. Although most chronic wounds are associated with diabetes or chronic venous insufficiency, rare etiologies should also be considered. One such cause is envenomation by Phoneutria spp. (native to South America, rare in Europe). Their venom contains potent neurotoxins. While systemic manifestations are more commonly reported, localized necrotic skin lesions may also occur. This case report presents a rare chronic wound following a suspected Phoneutria spider bite and highlights the importance of an individualized, multimodal treatment approach. A 61-year-old male patient with a progressive thigh wound following a spider bite sustained during work. Despite initial self-treatment and pharmacotherapy the wound deteriorated. The patient was admitted to the authors’ facility, where surgical treatment included necrosectomy and a sandwich graft using an acellular dermal matrix combined with a split-thickness skin graft. Adjunctive therapies included negative pressure wound therapy and hyperbaric oxygen therapy. After discharge, outpatient wound care was continued. Treatment was monitored with photographic documentation and serial microperfusion measurements. Complete wound closure was achieved after 4 months of specialized therapy. Management of chronic wounds requires a multidisciplinary and individualized approach with surgical intervention, advanced wound care and specialized outpatient follow-up.