A 25-year-old male who suffered while fishing for ray sting at the level of the internal surface of the right ankle, with severe health pain and presenting clinical manifestations, was initially treated in a local hospital with cure and administration of systemic antibiotics.
Upon admission, the patient had a very painful, deep lesion at the posterior region of the internal malleolus of the right foot, with necrosis of the overlying skin and abundant output of purulent material and fetid.
Bladder tissue infection was diagnosed and she was hospitalized for surgical debridement and treatment with antibiotics (Clindamycin 600 mg every 8 hours and Amikacin 1 g daily).
Radiographs of the right ankle were taken in which edema of soft tissues was observed, with no evidence of radio-opaque fragments that could correspond to remnants of the venomous aguide.
In the operating room, the collection of purulent material was drained and necrotic tissue debridement was performed, creating a tissue defect of 7 x 5 cm on the internal malleolus of the right ankle Achilles tendon, with exposure of the posterior tibia tissue.
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Laboratory tests reported leukocytes of 7200/ul, with neutrophils of 60%, hemoglobin 10.7g/dl, hematocrit 31.8%, creatinine 0.9 mg/dL, C-reactive protein 3.13mg/dL and sediment speed 81 mm.
We performed two additional debridements due to persistent secretion and residual necrotic tissue on the third and fifth day of hospitalization.
Culture results detected the presence of Proteus vulgaris sensitive to Amikacin.
Towards the 9th day, we performed coverage of the remaining defect with reverse flow fasciocutaneous saphenointerne flap.
We debrided the edges of the defect, leaving a final substance loss of 8x3 cm; for coverage we designed a skin island with the same dimensions and then closed primarily the flap donor area.
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The evolution of the patient was satisfactory, with adequate control of the infection and successful healing.
