# Deep Subcutaneous Tick Embedding Following Prolonged Attachment: A Case Report and Mini-Review of Tick Fixation Mechanisms

## TL;DR

A case report shows that deeply embedded ticks may require surgical removal due to their strong attachment mechanisms.

## Contribution

The paper highlights the need for surgical intervention in cases of deep tick embedding due to unique fixation mechanisms.

## Key findings

- Prolonged tick attachment can lead to deep subcutaneous embedding in humans.
- Standard tick removal tools may fail to fully extract deeply embedded ticks.
- Surgical exploration may be necessary to remove residual tick parts safely.

## Abstract

Prolonged tick attachment with deep subcutaneous embedding is uncommon in humans but may complicate tick removal in primary care. Firm fixation is mediated by the tick’s barbed hypostome and the secretion of glycine-rich salivary cement, which together anchor the mouthparts within the dermis. Awareness of these mechanisms is important when standard extraction techniques fail. A patient presented with a live, engorged tick deeply embedded in the skin after several days of attachment. The tick’s anterior body and mouthparts were firmly fixed within the dermis, and surrounding erythema migrans was observed. Initial removal using a tick tweezer was incomplete due to persistent fixation, necessitating minor surgical exploration to extract residual fragments. This case highlights that prolonged and unusually firm tick attachment can occur and may require surgical removal when conventional extraction is unsuccessful. Recognizing the mechanical and biochemical mechanisms of tick fixation can guide safe management, prevent retained mouthparts, and support favorable outcomes in primary care.