A 25-year-old man was stung by a stingray while fishing on the inner surface of the right ankle, with intense, burning pain, initially treated at a local hospital with treatment and administration of systemic antibiotics; as he did not show an adequate clinical response, he was referred to our health institution.
On admission to hospital, the patient presented with a very painful, deep lesion in the posterior region of the internal malleolus of the right foot, with necrosis of the overlying skin and abundant discharge of purulent and fetid material.
We diagnosed soft tissue infection and he was hospitalised for surgical debridement and antibiotic treatment (Clindamycin 600 mg every 8 hours and Amikacin 1 g daily). X-rays were taken of the right ankle in which soft tissue oedema was observed, with no evidence of radio-opaque fragments that might correspond to the remains of the venomous sting.
In the operating theatre, drainage of the collection of purulent material and debridement of the necrotic tissue were performed, creating a 7 x 5 cm tissue defect on the internal malleolus of the right ankle, with exposure of the Achilles tendon and the posterior edge of the tibia; soft tissue culture was also performed.

Laboratory tests showed: leucocytes 7200/ul, with 60% neutrophils, haemoglobin 10.7g/dL, haematocrit 31.8%, creatinine 0.9 mg/dL, C-reactive protein 3.13mg/dL and erythrocyte sedimentation rate 81 mm.
We performed two additional debridements due to persistent discharge and residual necrotic tissue on the third and fifth day of hospitalisation. The culture result detected the presence of Proteus vulgaris, sensitive to Amikacin.
On the 9th day, we decided to cover the remaining defect with a reverse-flow saphenous-internal fasciocutaneous saphenous-internal flap. We debrided the edges of the defect, leaving a final loss of substance of 8x3 cm; for the coverage we designed a skin island with the same dimensions and then we closed the donor area of the flap in a primary way.

The patient's evolution was satisfactory, with adequate infection control and successful healing.

