CASE REPORT Management of Periauricular and Auricular Necrotizing Wound From Brown Recluse Spider Bite Using Negative Pressure Wound Therapy and Wound Interface Modulation

Brown recluse spider (Loxosceles reclusa) envenomation, known as loxoscelism, can produce a wide range of consequences. The symptoms may range from itching to wound necrosis, which may ultimately result in death.1 Biopsies of loxoscelism wounds show evidence of acute inflammation, hemorrhage, thrombosis, induration, and liquefactive necrosis of the dermis and the epidermis.2 These effects are attributed to proteolytic toxins in the venom that degrade tissue and cause gravitational spreading of the lesion and dysregulated activation of neutrophils, which is suspected to be involved in dermonecrosis.2 Treatment includes early recognition, cool compresses for mild itching, a possible trial of the leukocyte inhibitor dapsone, and hyberbaric oxygen for chronic lesions.1 The resultant wound, especially in the head and neck area, necessitates innovation to maintain the tenants of open wound care including moist wound care, prevention of normal adjacent skin maceration, protection of critical structures in the area, and creation of a dynamic wound environment. These tenants are also features of negative pressure wound therapy (NPWT) dressings. We describe the use of this type of dressing for a necrotizing wound caused by a brown recluse spider bite. There is a paucity of literature that illustrates the use of NPWT specifically on auricular wounds. No articles were discovered during the research for this article that documented the use of NPWT on an ear with an intact external auditory canal.3 It is plausible that the application of negative pressure over a wound that includes the auditory canal could potentially perforate the tympanic membrane. Although no perforations have occurred in our institution, the use of negative pressure directly over the ear canal and the tympanic membrane is painful for children and has prevented the use of NPWT in this area. One technique used by clinicians using NPWT is adding a contact layer over certain structures