How long does it take a stingray wound to heal? Explore the factors that influence the healing time and get a comprehensive overview of stingray envenomations and their management.

Understanding Stingray Envenomations

Stingrays are a type of cartilaginous fish that belong to the Chondrichthyes class, which also includes sharks and skates. These aquatic creatures are characterized by their flat bodies and enlarged pectoral fins that are permanently fused to their heads. The most dangerous aspect of a stingray is its tail, which houses a spinal blade, also known as its stinger or barb.

Stingrays possess between one and three of these spinal blades, which are covered in sharp spines made of a cartilaginous material called vasodentin. The venom is not stored in a gland but rather within the secretory cells along the grooves on the underside of the spine. Freshwater stingrays, in particular, have a more potent venom due to their higher concentration of secretory cells along the blade.

Epidemiology of Stingray Injuries

Stingrays are widespread throughout tropical marine and freshwater environments, with over 150 species worldwide, ranging in size from inches to 6.5 feet and weighing up to 800 pounds. These encounters often occur in or near coral reefs, leading to frequent human injuries. In the United States, there are approximately 750 to 2000 reported stingray injuries annually, while the incidence is estimated to be much higher in tropical regions with freshwater stingrays, potentially reaching thousands of cases per year.

Demographic data shows that stingray injuries are more common in males, with an average age of 28 years (range 9 to 68 years old). The most common site of injury is the lower extremities, followed by the upper extremities. While the majority of stingray injuries have low morbidity, serious injuries and complications are more prevalent in freshwater stings compared to marine stings.

Pathophysiology of Stingray Envenomations

Stingrays are not known to be aggressive, but they will use their tails to puncture and envenomate potential threats, such as predators or unsuspecting swimmers and divers who accidentally step on them. The mechanism of injury involves both mechanical and venomous components.

The barbs on the stingray’s tail pierce through the skin, causing a laceration or puncture wound. In some cases, these wounds can lead to more serious complications, such as arterial or spinal cord injury. Additionally, the sheath of the barb can remain embedded in the patient’s skin, requiring debridement for removal.

The venom of the stingray is known to be heat-labile and cardiotoxic, causing a range of symptoms, including severe pain, headaches, diaphoresis, vertigo, nausea, vomiting, diarrhea, syncope, muscle cramps, fasciculations, dyspnea, cardiac arrhythmias, hypotension, and seizures.

Initial Management of Stingray Injuries

When a patient presents with a stingray injury, the immediate priorities are the removal of any retained barbs, wound care, and immersion of the affected area in hot water to inactivate the toxin. The hot water treatment, typically at a temperature of 42-45°C (108-113°F), helps to denature the venom and alleviate the associated pain.

Depending on the severity of the injury, additional medical interventions may be required, such as debridement, antibiotic administration, and pain management. In more serious cases, patients may need to be monitored for potential complications, such as cardiac arrhythmias or neurological symptoms.

Factors Influencing Stingray Wound Healing Time

The healing time for a stingray wound can vary depending on several factors, including the severity of the injury, the presence of any retained barb fragments, and the development of complications. Generally, minor puncture wounds or lacerations may heal within a few days to a week, while more complex injuries may take several weeks or longer to fully recover.

Proper wound care, including cleaning, debridement, and the application of topical antibiotics, is crucial in promoting timely healing. The use of hot water immersion can also help to reduce inflammation and pain, which can facilitate the healing process.

In cases where the stingray barb remains embedded in the skin, the healing time may be prolonged, as the retained fragment will need to be surgically removed before the wound can fully close. The development of complications, such as infection or nerve damage, can also significantly impact the healing timeline.

Preventing and Avoiding Stingray Injuries

To reduce the risk of stingray injuries, it is recommended to shuffle or slide one’s feet through the sand rather than taking steps, as this can help to alert the stingray to your presence and allow it to swim away. Additionally, wearing protective footwear, such as water shoes or wading boots, can provide a barrier against accidental stings.

If a stingray injury does occur, it is crucial to seek immediate medical attention, as the venom can cause severe and potentially life-threatening complications if left untreated. Prompt first aid measures, such as hot water immersion and wound care, can also help to minimize the severity of the injury and facilitate the healing process.

Conclusion

Stingray envenomations can result in a range of injuries, from minor puncture wounds to more serious complications, depending on the location and severity of the sting. The healing time for a stingray wound can vary significantly, but proper management and prompt medical attention are essential for a favorable outcome. By understanding the factors that influence the healing process and taking preventive measures, individuals can reduce the risk of stingray injuries and promote a timely and uneventful recovery.

Stingray Sting – StatPearls – NCBI Bookshelf

Continuing Education Activity

Stingray envenomations are common injuries. Practitioners should recognize that these injuries vary in level of severity, and clinical concerns should vary accordingly. The type of stingray involved and the anatomical region of injury affect the associated morbidity and, in some cases, mortality. Short-term management includes the removal of any retained barbs, wound care, and immersion of the injury in hot water to inactivate the toxin. This activity outlines the evaluation and treatment of stingray stings and reviews the role of the interprofessional team in the care of patients with this condition.

Objectives:

• Review the risk factors for stingray envenomation.

• Outline the management of stingray envenomation.

• Describe the complications of stingray envenomation.

• Summarize the importance of collaboration among interprofessional team members to enhance the care of stingray injuries and improve outcomes for affected patients.

Access free multiple choice questions on this topic.

Introduction

Stingrays are a subset of the cartilaginous fish commonly known as rays. Rays are members of the Chondrichthyes class, which also includes sharks and skates. All rays share a flat body with enlarged pectoral fins that permanently fuse to their heads. The mouth of a stingray is on the ventral side of the animal. The most dangerous aspect of the stingray is the tail due to the spinal blade, also known as its stinger or barb. Rays with longer spines located more distally on their tail represent the greatest danger for sting injuries.[1]

Etiology

Stingrays can have between one and three spinal blades. The stinger is covered with rows of sharp spines made of vasodentin, a cartilaginous material that can easily cut through the skin. The stingray is unique from other venomous animals in that the venom storage is not in a gland. The venom is stored inside its own secretory cells within the grooves on the undersides of the spine. Freshwater stingrays have more secretory cells that cover a larger area along the blade. Because of this fact, freshwater stingrays have a venom that is more toxic than that of their saltwater relatives. The venom of the stingray has been relatively unstudied but is known to be heat-labile and cardiotoxic.[1][2]

Epidemiology

Stingrays are very common throughout tropical marine waters and freshwaters. There are over 150 species of stingray worldwide, ranging in size from inches to 6.5 feet and in the larger species weighing as much as 800 pounds. Stingrays often feed in or near coral reefs, causing frequent human injuries. In the United States, there are approximately 750 to 2000 stingray injuries reported annually.[3] There are estimated thousands of cases per year in tropical regions with freshwater stingrays that occupy inland rivers.[3] In one retrospective review of 119 cases seen in a California emergency department over 8 years, 80% of stingray victims were male, with an average age of 28 years (range 9 to 68 years old). [4] In a prospective study of freshwater stingray injuries in Brazil, 80% to 90% of the injuries were in men.[5] The most common site of injury is the lower extremities, followed by the upper extremities.[4][5] The majority of stingray injuries have low morbidity, with higher rates of serious injuries and complications in freshwater stings compared to marine stings. In the United States and Indo-Pacific nations, fatalities related to stingray injuries occur one to two times a year, compared to fatality rates up to 8 per year in South American nations related to Amazonian stingrays.[3]

Pathophysiology

Stingrays are not known to be aggressive, nor are they known to act defensively. In fact, the primary defensive action of the stingray is simply to swim away from the area. However, when attacked by a predator or stepped on, the ray will use its tail to puncture and envenomate its potential attacker. Human injuries are most common on the extremities of swimmers and divers and those who accidentally step on a stingray. One way to prevent this is to slide or shuffle through the sand instead of walking.

The mechanism of stingray stings includes both mechanical and venomous injury. First, the barbs pierce through the skin, causing a laceration or puncture wound. In most cases, these wounds are minor, but there are reports of arterial or spinal cord injury related to stingray wounds. The sheath of the barb can also remain in the patient’s skin, which may require debridement for removal. The most common venomous effect is severe pain, but the venom can also cause headaches, diaphoresis, vertigo, nausea, vomiting, diarrhea, syncope, muscle cramps, fasciculations, dyspnea, cardiac arrhythmias, hypotension, and seizures.[4][6]

History and Physical

Patients will present with a puncture wound or laceration and report pain out of proportion to the wound. They will often have a known exposure to a stingray or may have a wound on their foot and report that they stepped on something in the ocean. The onset of severe pain is usually immediate. It reaches maximum intensity within 30 to 90 minutes and can last for up to 48 hours.[6] The site of the wound may have evidence of edema and discoloration. In delayed presentations, there may be evidence of local necrosis. Patients may also report systemic symptoms such as nausea, vomiting, diarrhea, lightheadedness, syncope, shortness of breath, headache, abdominal pain, vertigo, or seizures.[3]

Evaluation

The wound should be evaluated using standard procedures, including irrigation of the wound. Plain films may be obtained to evaluate for foreign bodies at the discretion of the provider. Stingray barbs are radioopaque and are visible on plain films. There is not currently a recommended standard for obtaining radiographs in stingray injuries. However, in one retrospective review, 57% of patients had radiographic imaging. Foreign body identification was found in only 2 cases of 119 (and only definitively in one case; there was a possible barb in the other case). [4] 

If the patient presents with an injury to the chest or abdomen or severe systemic symptoms, consider an electrocardiogram (EKG), cardiac monitoring, lab work, and chest radiography. If there is a concern for severe systemic illness, including cardiogenic shock, the patient should be transferred to a facility with ICU capabilities, and a medical toxicology consult may be obtained.

Treatment / Management

The standard treatment for stingray injuries is hot water immersion.[4][6][7] Stingray venom is heat-labile and can be inactivated by heat. Water should be heated to a temperature that will not result in burns, and the temperature should be tested on a non-affected extremity, as the patient may have impaired sensation on the injured extremity. Hot water immersion should be initiated as soon as possible, ideally in the field by lifeguards or paramedics. A small prospective study found that hot water immersion alone resulted in statistically significant pain reduction. [7] Another retrospective study found that hot water immersion alone provided effective pain relief in 9 out of 10 patients. Oral NSAIDs or opioids were used concurrently with hot water immersion in the other 10% of patients. Only 2% of patients required additional pain control at discharge.[4] In patients with freshwater stings in Brazil, hot water immersion was found to help reduce pain but did not decrease rates of skin necrosis.[5]

In addition to hot water immersion, standard wound care techniques should be applied. Irrigate the wound. If there is suspicion for a retained foreign body, obtain radiographs, explore the injury and remove any foreign bodies as they may result in delayed healing and wound necrosis. If the wound is small, it should be left to close by secondary intention or delayed primary closure, due to the risks of infection. Tetanus status should be inquired about and tetanus immunizations updated as necessary. If there is evidence of necrosis, the wound should be debrided. [3] 

There is not a clear consensus on whether antibiotic prophylaxis should be given with some experts arguing that most injuries are minor and prophylaxis should only be given for deep penetrating wounds, wounds complicated by a foreign body, or patients who are immunocompromised. However, in a retrospective review, 70% of patients were prescribed prophylactic antibiotics on initial presentation, and only one patient returned with possible early wound infection. Of the 30% of patients not prescribed antimicrobial prophylaxis, 17% returned with signs of wound infection.[4] Antibiotic prophylaxis, therefore, seems prudent, and coverage should include gram-negative species, including Vibrio, as well as Staphylococcus and Streptococcus.

Prognosis

Stingray injuries, whether through puncture, laceration, or envenomation, usually have a good prognosis. It is important to instruct patients to look for signs of infection after discharge. While it is possible to develop further complications such as infection, most patients will have a significantly decreased amount of pain in one to two days after the incident. Necrosis following marine envenomations was rarely reported in the United States but reported at high rates after freshwater stings in Brazil. A study of 84 freshwater stings in Brazil reported a rate of ulcers and necrosis in 90.4% of cases. The ulcers lasted approximately 3 months and often resulted in scars.[5] 

Systemic toxicity or death related to stingray stings is rare and associated with stings resulting in penetrating trauma to the abdomen, chest, or neck resulting in a cardiac laceration, cardiac tamponade, pneumothorax, airway compromise, or hemorrhagic shock. There are cases of delayed fatality secondary to septic shock, osteomyelitis, gangrene, and wound botulism from an infected wound.[3]

Complications

The most common complication of stingray sting is wound infection or necrosis. There are significantly higher rates of skin necrosis associated with freshwater stingray injuries.[5] There are case reports of necrotizing fasciitis following stingray injury. [8]

Consultations

For patients with severe toxic effects, including systemic illness, cardiogenic shock, syncope, shortness of breath, or seizures, a medical toxicology consult may be obtained. The local Poison Control Center may also be a useful consult for these patients.

Deterrence and Patient Education

Stingrays are generally docile animals and are not known for actively attacking humans unless threatened. Stingray injuries can be prevented by encouraging swimmers, divers, and beach-goers to avoid provoking stingrays. Most injuries occur due to accidentally stepping on a ray. This can be prevented by shuffling through the sand without lifting the feet or using a stick or pole to poke the sand ahead of placing the feet. Divers should avoid swimming too close to the seafloor. A fisher who accidentally catches a stingray should not attempt to disentangle it from a net or line.[3]

Enhancing Healthcare Team Outcomes

An interprofessional team approach to managing stingray injuries includes proper training of local medics and lifeguards. Many patients with minor stingray injuries do not present to healthcare facilities and may be managed in the field setting by these first responders. In a review of 153 stingray cases reported to Texas poison centers, 61% were not managed in healthcare facilities.[9] First-responders should be trained to immerse stingray wounds in hot water. They should also require training to transfer the patient to a medical facility for wounds with ongoing bleeding, deep penetration, evidence of systemic toxicity, ongoing pain, or patients with comorbid medical conditions. Within the emergency department setting, nurses and technicians are integral in ensuring that the patient has continuous hot water immersion for 30 to 90 minutes. Emergency clinicians should promptly manage any severe effects of the toxin or wound. Medical toxicology may be consulted for severe effects as well.

Figure

Sting ray with barb. Image courtesy S Bhimji MD

References

1.

O’Connell C, Myatt T, Clark RF, Coffey C, Nguyen BJ. Stingray Envenomation. J Emerg Med. 2019 Feb;56(2):230-231. [PubMed: 30738566]

2.

Sachett JAG, Sampaio VS, Silva IM, Shibuya A, Vale FF, Costa FP, Pardal PPO, Lacerda MVG, Monteiro WM. Delayed healthcare and secondary infections following freshwater stingray injuries: risk factors for a poorly understood health issue in the Amazon. Rev Soc Bras Med Trop. 2018 Sep-Oct;51(5):651-659. [PubMed: 30304272]

3.

Diaz JH. The evaluation, management, and prevention of stingray injuries in travelers. J Travel Med. 2008 Mar-Apr;15(2):102-9. [PubMed: 18346243]

4.

Clark RF, Girard RH, Rao D, Ly BT, Davis DP. Stingray envenomation: a retrospective review of clinical presentation and treatment in 119 cases. J Emerg Med. 2007 Jul;33(1):33-7. [PubMed: 17630073]

5.

Haddad V, Neto DG, de Paula Neto JB, de Luna Marques FP, Barbaro KC. Freshwater stingrays: study of epidemiologic, clinic and therapeutic aspects based on 84 envenomings in humans and some enzymatic activities of the venom. Toxicon. 2004 Mar 01;43(3):287-94. [PubMed: 15033327]

6.

Meyer PK. Stingray injuries. Wilderness Environ Med. 1997 Feb;8(1):24-8. [PubMed: 11990133]

7.

Myatt T, Nguyen BJ, Clark RF, Coffey CH, O’Connell CW. A Prospective Study of Stingray Injury and Envenomation Outcomes. J Emerg Med. 2018 Aug;55(2):213-217. [PubMed: 29803633]

8.

Ho PL, Tang WM, Lo KS, Yuen KY. Necrotizing fasciitis due to Vibrio alginolyticus following an injury inflicted by a stingray. Scand J Infect Dis. 1998;30(2):192-3. [PubMed: 9730311]

9.

Forrester MB. Pattern of stingray injuries reported to Texas poison centers from 1998 to 2004. Hum Exp Toxicol. 2005 Dec;24(12):639-42. [PubMed: 16408617]

Prevention & Treatment of Stingray Injuries

The Full Story

The stingray has a fierce reputation and is best known for its infamous tail – long, thin, and whip-like with one to three barbed venomous spinal blades. In Greek mythology, Odysseus was killed when his son Telegonus unintentionally stabbed him using a spear tipped with the spine of a stingray. In 2006, television personality and animal activist Steve Irwin, best known as The Crocodile Hunter, died after being pierced in his chest by a stingray. Stingrays pose a threat to fishermen and beachgoers. Every year, about 1,500-2,000 stingray injuries are reported in the US.

Contrary to its reputation, the stingray is a shy and even gentle creature that would rather swim away than strike. It reserves its stinger for its predators – sharks and other large carnivorous fish. It attacks people only when it feels directly threatened, often when it’s unintentionally stepped on.

Stingrays are flat and can vary in size from several inches to 6.5 ft. in length and weigh up to 800 lbs. Their wing-like fins create ripples in the water as they swim. There are 11 species of stingrays found in the coastal waters of the US. Their flat bodies and gray color allow them to be camouflaged on the sea floor, where they move slowly to forage for their prey (small fish and crustaceans like crabs and sea snails). Interestingly, a stingray cannot see its prey because its eyes are on the upper side of its body, while its mouth and nostrils are on the underside.

The dangerous part of a stingray is its infamous tail. The spinal blade is also known as the stinger or barb. This stinger is covered with rows of sharp spines made of cartilage and is strong enough to pierce through the skin of an attacker. Not only does the puncture itself cause injury and pain, but the stinger also releases a complex venom, which leads to intense pain at the puncture site. Uncommon effects of the venom include headaches, nausea and vomiting, fainting, low blood pressure, arrhythmias of the heart, and even seizures.

The most common sites of human envenomation are the legs and feet, which makes sense because the most common reason for envenomation is a swimmer unintentionally stepping on a stingray. The envenomation is often limited to severe pain that is relieved when the area is submerged in hot water. However, complications such as infection, serious bleeding, or physical trauma can occur. Part of the spine can also remain embedded in the tissue and require medical intervention to remove it. Death is extremely rare and results not from the venom but from the puncture wound itself if it is in the chest, abdomen, or neck. Death from serious infections like tetanus has also been reported.

Treatment of stingray injuries starts with first aid. Because the puncture is often deep and considered dirty, there is high risk of infection. It’s important to wash and disinfect the area immediately and obtain a tetanus vaccine or booster if needed. The wound should be inspected for any retained spines. The standard treatment for the pain is hot water immersion. Medical evaluation and treatment in a hospital is necessary if there are any retained spines in the wound, if the puncture is deep, or if it involves the chest, abdomen, or neck.

The best way to prevent being stung by a stingray is to avoid stepping on it when in the ocean by shuffling through the sand rather than lifting your feet and walking normally (commonly referred to as the “stingray shuffle”). This will warn a stingray of your approach, and it will likely swim away. A pole or stick can also be used ahead of your feet. Divers should be cautious and avoid swimming close to the sea floor. It is also important to know where stingrays are and never provoke them.

If you have a stingray injury, check the webPOISONCONTROL^® online tool for guidance or call Poison Control at 1-800-222-1222.

Serkalem Mekonnen, RN, BSN, MPH
Certified Specialist in Poison Information

Stingray Envenomation: Background, Prognosis, Patient Education

Author

John L Meade, MD CEO, Statdoc Consulting, Inc

John L Meade, MD is a member of the following medical societies: American College of Emergency Physicians, Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph’s Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Richard S Krause, MD Senior Clinical Faculty/Clinical Assistant Professor, Department of Emergency Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

“Ouch, I got Stung”: What You Need to Know about Stingrays, Stings and Injuries

We’ve all heard it before, “Do the ‘stingray shuffle’.” Well, what happens if you do the shuffle but still get stung?

Like many of us who live in Pinellas County, I went to the beach on Memorial Day. I shuffled through the sand on St. Pete Beach, dipped my head in and floated around in shoulder deep water. “Ouch!” I yelped about two minutes later. I started swimming to shore and said to my husband, “Something bit me!”. 

Once I made it to shore, I sat on the sand and found a very small, paper-cut looking “stab” or “bite” in between my two small toes on my right foot. It hurt, but it was bearable. But, after sitting in the shallow water for about 15 minutes, I felt the pain settling in. It felt like a shooting pain, moving up my foot: it was the venom. I gathered that the “wound” shouldn’t hurt that bad if I stepped on a shell. About 15 minutes after that, my husband and I were in the truck headed to the emergency room at the .

Let’s just say that the pain increased, to the point of tears and minor yelps in the truck. By the time we made it to the ER, it was about 45 minutes after the initial “sting”. The pain increased significantly and I needed a wheelchair to make it inside. As soon as I checked in, the ER nurse had a bucket of hot water. I tested it first, and then put my foot in. Within minutes the pain decreased. It still hurt, but it felt better. During my treatment, the ER doctor confirmed it was a sting, had my foot x-rayed and recommended a Tetanus shot. I left about and hour later, went home and continued to soak my foot. In all, I soaked my foot for about 3 to 4 hours. It’s day five and my foot is fine!

Here is what you need to know before heading to the beach:

• Do the stingray shuffle: When getting into the water, shuffle your feet forward, one at a time. Do not step or stomp down into the sand. By shuffling your feet, you create vibrations and kick up sand to alert nearby stingrays that you are there.
• You can go one step further and use a stick to poke around you and help scare away stingrays. 
• Stingrays usually travel together. If you see one, there may be several in the area.
• Stingrays are not aggressive. They sting because they feel threatened, it’s a defensive maneuver. Most injuries are minor.
• When stung, the stingrays inject a protein-based venom that will cause pain near the wound. While it can be very painful, it’s rarely deadly. The toxicity of the venom does not vary for age. “The venom is the same from birth to death,” Lt. Bill Gorham with thesaid.

Gorham says this season is pretty average, however, because of a cold winter, the normal late April/early May spike in stings has been “pushed back” to late May/early June. “They’re showing up now,” he said. “When the mating season is over, April seems to be the time when the babies are up towards the shore.”

Emergency Room staff at Palms of Pasadena Hospital say they’re seeing an increase in stings this season. Palms of Pasadena Hospital EMT Brian Jollimore says, “We seem to be having an active season.” The hospital does not track injuries by “stings” only listed by “puncture” or “laceration”, so there aren’t any hard numbers.

How do you know if you’ve been stung?:

• If you step on or alarm a stingray, they whip their tail around their body and a stinger lashes out and cuts or pierces you. The stinger then injects a venom. 
• Officials say the pain from the venom increases about 30 minutes after the sting and it peaks around one hour from venom injection. You may feel shooting pain.
• Other symptoms include: swelling, bleeding at point of injury, headache, nausea, vomiting and weakness.
• If the stinger breaks off, you will feel more pain from the “object”, that will have to be removed by medical staff.

Lt. Gorham says, “I’ve been here at the beach for 13 plus years, I have yet to run on a stingray call where a barb has broken off.”

What to do if your stung:

• Remove any clothing from the affected area.
• Do not put ice on the wound. Lt. Gorham says the venom injected by the animal is a “heat-seeking” toxin. Meaning, it originates from the wound and moves up your body towards areas of heat, such as your abdomen and stomach. If you put ice on the wound, it only causes the venom to circulate faster.
• Treat the wound by placing your foot or leg in a bucket of very warm or hot water. Gorham says the water will draw the venom out of your body and alleviate the pain. It’s suggested to leave your foot in hot or very warm water for at least one to three hours. Lt. Gorham says many of the hotels and concession stands are understanding and will help if you approach them. Otherwise, you may go straight to an emergency room or hospital and seek medical attention. If you don’t seek medical attention right away, you should still see have the wound checked out by a doctor soon after the sting.
• Once you’ve made it to a hospital or emergency room, officials will take an X-ray of the wound to make sure the barb or shards of the barb are not stuck. EMT Jollimore says the main concerns with the actual puncture with the barb are: infection, hitting a vein, having the barb or pieces in your foot. 
• If you are not up-to-date on your tetanus vaccination, you may need a shot. The vaccine will prevent tetanus infection.

Lt. Gorham says, “It’s a very clean process, the problem with infection comes from the water. . . It’s a steril transition between you and the stringray.”

Can people die from venom alone? 

EMT Jollimore says “yes”. If a person has an allergic reaction to the venom and does not seek medical attention right away. Symptoms include: drop in blood pressure, swelling and shortness of breath. Jollimore adds that if you think you’re having an allergic reaction, leave the water immediately. If you pass out in the water, there is a chance you could drown.

I Stepped on a Stingray: My Experience – Stuff!

**Over 4 years ago on September 9, 2013 while at the beach on vacation, I stepped on a stingray and it stung me. It was one of the worst pains I’ve ever experienced and at the time, I swore up and down that I wouldn’t even wish that on my worst enemy. Online searching yielded very minimal information, so I wrote this blog entry and it has been significant for those looking for information and sharing their own experiences to help others understand what they’re going through and what to expect. Because that was on my personal blog, I felt compelled over the years to move it somewhere else, and, here we are. Thank you for understanding. I’ve compiled all of the entries I have on the subject together in one place, and the experiences I’ll post as well for further reference.**

**Please continue to share your experiences here on this entry! Thank you for your contributions!**

How to manage a stingray sting: a quick overview (from personal experience and per reader testimony)

• Don’t:
  • Use cold therapy (i.e. ice)
  • Elevate above the heart
• Do:
  • Place affected area in very hot water (as hot as you can stand but not scalding that you burn yourself) until pain dissipates. Has a secondary effect of muscle relaxation to allow any remaining barbs to work its way out.
  • Visit a medical facility to get it checked out out for foreign bodies and some antibiotics just in case, whatever they recommend.
• Expect:
  • Pain.
  • Possible crying
  • A delayed reaction at the sting site at around the 1 week mark, with pain, itchiness and swelling that lasts a few days and then goes away.
  • Intermittent annoying pain, twinging, tingling, itchiness for about a year or until the wound fully heals.

Be sure to check out the existing contributions from fellow sting-recipients at the bottom and feel free to add your own experiences in the comments! 

I stepped on a stingray’s tail

September 9, 2013 – 64 Comments

What happened: I was out in the waves with my mom, and brother. It was a partly cloudy day. Initially, I thought I’d been pinched by a crab, or stepped on a broken shell. It hurt and I was bleeding, so I limped ashore and sat down on the sand to inspect it. There was a growing realization that it couldn’t possibly be either one of those because it became increasingly painful, and wholly unlike anything I’d ever experienced: dull and sharp at the same time, and coursed throughout my entire leg with every heartbeat.  I hobbled inside and tried to find information on the internet, but couldn’t find much, except, not to use cold therapy (ice) as it is described as “disastrous.” Same with elevating above the heart. Unfortunately for me, I’d read that after I had done exactly both of those things, and believe me: DON’T DO IT. I was trying to be brave and strong, but it got so bad and 30 minutes later it was worse and not disappearing in the least. I cried so hard as my mom tried to look at it, the neighboring vacationers were extremely concerned. My family rushed me to the nearest physician’s office we could find. Let me tell you: the drive was absolutely unbearable. Every heartbeat was excruciating as the venom circulated steadily through my leg. My pain-addled brain kept thinking I would have to amputate, it felt like the tissues were necrotizing in my leg with every wave!! The medical office treated me with warm water and gave me antibiotics (they also gave me insight into the fact that locals there don’t get in the water past July). Then I had to go to the nearest imaging facility (1 hour away) for an x-ray to make sure there was no foreign bodies still embedded.

Treatment includes placing the area in water as hot you can stand for 30-90 minutes… for me the pain relief was almost instantaneous. The hot water also works to relax the muscles and hopefully allow any piece of the stinger to drift out. There is no antivenin for stingrays. It is speculated that maybe hot water denatures the proteins that make up the venom, but others disagree with that hypothesis. What’s really important is making sure that there are no barbs from the stinger or other foreign bodies left within the wound. Most doctors will prescribe oral antibiotics in case of infection, given the nature of the environment that stingray stings occur in (ie saltwater, sand). The physician’s assistant down at the beach cut into the area (with local anesthesia) to make sure the barb was gone.

The days following and up until a week after the incident, the area felt 100% fine. It looked and felt like a papercut on the bottom of my foot, and I expected maybe some bruising as I tend to bruise easily. I kept bandaids on the site to prevent random opportunistic pathogens in, but it had already scabbed up after 2 days. After we arrived back home, I went to work as normal. The first day was more painful than I’d anticipated, but it was long before I forgot about it altogether.

Then, exactly 7 days later the area started itching. A couple things ran through my mind, like maybe the bandage was latex-based and my skin had had enough of it (I’m latex sensitive), and that this was a sting like a bee sting and would be bound to itch, so I didn’t think much about it. But. The next day after work, I grew increasingly alarmed. The area was very inflamed again and there was a sudden surge of little red dots all around the sting area, one of which looked like a double pustule. I put a bunch of hydrocortisone on it, worried about it and went to sleep. The next morning, I was 100% concerned. It looked BAD. The wound seemed cyanotic, the inflammation was a 4x4inch circle surrounding the puncture site, the little red dots were extremely pronounced, and it was hella itchy.

As soon as I could, I called the office down where I had been seen and talked with the PA who finally gave me the radiology report (nothing radiopaque evident in the tissues, but they did find an old evulsion fracture at the base of the 2nd toe). I told him about the condition of my foot and he wanted to see it, but I was long gone from the area. He then told me to go see my primary care physician and said that he would order an ultrasound at this point. I called my PCP and got in right away. Called work and they found a temp. Ran off the to doctor’s. The NP was like, yeah that’s not normal. No one knew what to do about stingray stings, so I volunteered what the PA told me. Sent me over to the radiology office to get an ultrasound and gave me a second round of the Augmentin I was on.

7 days – Looks normal for a cut8 days – starting to get bumps around the ankle! My feet are weird.9 days – At the doctor’s. This picture does NOT do it justice!!!! Round, cyanotic around the sting zone and the red bumps spreading around the ankle.10 days – bumps have melded together into a rash-looking patch around my ankle. Still dark looking circle around sting site

After waiting in radiology for about an hour, they let me go only to call me while I was waiting for my Augmentin to be filled at the pharmacy. The radiologist spoke with me, telling me that there was a LOT of fluid in the area and they couldn’t see anything. She had conversed with the NP and they want me back next Thursday for a re-evaluation, possibly a new ultrasound, and possibly a drainage of the area. I’m like, OK, so I schedule the appointment. Then the PCP calls me too, to say that the ultrasound was inconclusive and that I need to come back. The last time I had my ankle x-rayed it took forever for them to get back to me…then again they hadn’t been worried about anything.

So now it’s almost 2 weeks later. It feels and looks a ton better even though I spent the entirety of Saturday walking. The red dots all ended up melding together into a large rash on the inside of my ankle, but the inflammation has gone down and the area looks less cyanotic. I couldn’t take it anymore, though, and scratched the HELL out of it last night, opening up the scab and making myself just miserable (well, satisfied and miserable at the same time) because now it itches, burns AND hurts. The rash is not red anymore and now looks sort of dull gray, although the itchiness has spread to the back of my ankle. I’m hoping that by Thursday it’ll look good enough not to have to drain. It definitely hurts when I work, though. Such a pain to deal with while trying to work with patients.

2 Weeks Later – looks much better, eh?! You can still see the shadows of what was, but no redness anymore.

Aaaand there you have it.
I felt much better about the whole thing that day heading into the PCP. They saw me quickly this time, the assistant faked doing a BP, and the nurse bursts in happy that it’s looking so much better. I am given an appointment for a follow-up ultrasound. Once again, it was a quick turnaround, and before I know it the imaging is being done. This time as I follow on the screen, I can actually see and make out what’s going on. Clear as day I see the cavity in my foot. I wait again as the radiologist takes a look. He, himself, actually comes in this time to take a look at the foot himself. I describe to him what it used to look like and how now I don’t have to limp when I walk. He looked at it and I could see him juggling decisions in his mind before telling me that having drainage and surgery in the area is risky, so he would not recommend having it drained. Given the significant reduction in inflammation, I was advised to keep taking the rest of the antibiotics.

A few days later the PCP called to give me the official report. She said, “There is no evidence of a drainable abscess in the area.” Hopefully the antibiotics and my body will continue to fight the fight and naturally dispel the infection. No word on foreign bodies, so I’m assuming that there is not. The area on my foot is still purple, but for the most part it feels normal. Every so often it twinges and throbs a little (complaining heavily after I come home from work), but I’m of the mind that it’s better…? I guess only time will tell.

Stingray wound 5 months later

January 17, 2014 – 4 Comments

5 months later – Looks like a sting that’s healing. Just a small bump that sometimes itches and twinges

That’s what it looks like. 4mm x 6mm oval, pink, smooth, lightly raised lesion. I would have completely forgotten about it except that more recently it has been bothering me. In the past few months it would occasionally twinge, but in the last 2 weeks it twinges much more often to the point that it becomes a sharp pain. It never lasts long, but it’s enough for me to notice it and wonder what it going on.

My foot doctor patient a few months ago told me that the occasional twinge is normal. I wonder what he meant by that.

Stingray Sting: 7 months later

March 5, 2014 – 2 Comments

Another stingray update! It has been over half a year now since I stepped on the stingray’s tail. It certainly hasn’t gone away…in fact it is raised and hurts when pressure is put on it. It looks kinda creepy too, but it’s not uncomfortable enough for me to get it addressed again. No doubt everyone will just ponder over it, take some ultrasounds, and then send me on my way again. If I step on my foot the wrong way, it hurts, so it makes me thankful that it didn’t sting closer to the middle of my foot. If it had, then I most likely would need it addressed. My guess is that my body is trying to push the rest of the injury out, slowly. Either that or scar tissue has overgrown the area. I feel like it’s not getting worse…potentially even a little better.

I’ll keep monitoring it. In the meantime, here are some pics:

Reader Comments

1. Anonymous
   

   aowam
   September 26, 2013 at 7:02 am Edit
   When I was reading around on the internet, having the area inflame after a week was not unheard of. I’d be curious to know if yours does that too. Not to say that I’m glad you got stung because omg the pain!! I will also take the moment to say that I don’t think the one that got me was as big as yours (not that I saw anything). Now a month later, the area still has a scab, it still looks blackish, but it only tingle-hurts occasionally. Hopefully it’s just healing and I didn’t suffer too much nerve damage. I wish you the best while it heals and that you don’t get an abscess like I did. 🙂

2. Anonymous

    

3. Lisa
   April 16, 2014 at 4:28 pm Edit
   I was stung by a stingray and 7 days after mine started itching like crazy! I was lucky that the Dr in my Instacare use to work in Hawaii! He said that there is a small percentage of people who are allergic to tiny barbs inside. He said it would take months to heal on its own or he could give me a steroid shot and it should be healed in a week. I went for the shot and the itching and pain was gone in a hour. The entire sting was healed within a week or so but there was no more pain or stinging. Just wanted to pass it on for others that might be looking for answers.
   1. aowam
      April 24, 2014 at 10:20 pm
      Now I kind of wish I’d gotten a shot like that. Would’ve been a heckuvalot easier to deal with.
   2. Christie
4. Ian
   April 24, 2014 at 6:18 pm Edit
   I was stung last week at Pass A Grille Beach in St. Petersburg, Florida. The ray got the top of my foot, so all the bones up there prevented deep penetration. I did not seek medical attention, as the pain went away quickly and a doctor friend of mine said that if you don’t feel any more pain, then there is unlikely to be any barbs under the skin. It scabbed over, then the scab came off after a day of walking in dress shoes. I put on Polysporin and a Band-Aid, and now the wound is is unbearably itchy…
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A Cautionary Tale on JSTOR

Abstract

Stingray spine use in Maya human bloodletting rituals has long been an accepted phenomenon. Recent work has suggested that intact spines may have been used and that the symptoms resulting from envenomation were an important part of the bloodletting ritual. Zoological and medical research, however, indicate that stingray toxins pose a more serious threat to human health than mere pain and inflammation. Medical studies conducted to track injuries resulting from stingray attacks report that some two-thirds of all cases result in tissue necrosis. Reconciling the use of stingray spines by the Maya with the physiological effects they present is crucial if we are to understand how the Maya viewed toxic marine materials and why they incorporated them in their ritual behaviors. Correlations between political events and stingray spine use may hold the key for understanding how these objects were articulated into the larger social and political sphere. We provide a discussion of the effects of stingray envenomation and the health risks inherent to the ritual use of stingray spines as bloodletters among the ancient Maya. Finally, we offer some possible explanations for the role of cleaned and defleshed spines in ritual contexts. /// El uso de las espinas de manta raya en rituales de sangría maya es un fenómeno largamente aceptado. Trabajos recientes sugieren el uso de espinas frescas y que los síntomas que resultan del envenenamiento eran una parte importante del ritual. Sin embargo, la investigación zoológica y médica indica que sus toxinas son una amenaza más seria para la salud humana que el mero dolor y la inflamación. Análisis médicos que rastrean los efectos resultantes de ataques de manta rayas indican que dos tercios de los casos resultan en necrosis de los tejidos. Conciliar el estudio del uso de las espinas de manta raya con los efectos fisiológicos que ocasionan es vital si queremos entender como los Mayas percibían las sustancias tóxicas marinas y las razónes por la que los incorporó a sus rituales. La correlación entre eventos políticos y el uso de estas espinas pueden ser la llave para comprender cómo estos objetos se articulaban en las esferas sociales y políticas más amplias. Discutimos los efectos y riesgos en la salud por el envenenamiento relacionado con el uso de estas espinas para realizar sangrías en los rituales mayas. Finalmente, presentamos posibles explicaciones del rol de espinas descarnadas y limpias en contextos rituales.

Journal Information

Latin American Antiquity is a quarterly journal devoted to special reports on archaeology, prehistory, and ethnohistory in Mesoamerica, Central America, South America, and culturally related areas.

Publisher Information

Cambridge University Press (www.cambridge.org) is the publishing division of the University of Cambridge, one of the world’s leading research institutions and winner of 81 Nobel Prizes. Cambridge University Press is committed by its charter to disseminate knowledge as widely as possible across the globe. It publishes over 2,500 books a year for distribution in more than 200 countries.

Cambridge Journals publishes over 250 peer-reviewed academic journals across a wide range of subject areas, in print and online. Many of these journals are the leading academic publications in their fields and together they form one of the most valuable and comprehensive bodies of research available today. For more information, visit http://journals.cambridge.org.

Avoid stingrays this summer | California Sea Grant

As the June gloom lifts off of Southern California beaches, and the sunshine and waves beckon, it’s a good time to review stingray safety.

How to avoid stingrays? The stingray shuffle.

Shuffle or drag your feet along the bottom to scare away stingrays, says Captain Joe Bailey with the Seal Beach Lifeguards in Orange County.

You don’t want to sneak up on a stingray because its response will be to keep still and stay hidden, says Chris Lowe, a marine biology professor with California State University at Long Beach, who has had USC Sea Grant support to study rays.

How should you treat a stingray sting?

Soak the injured area in hot, but not scalding, water.

Lifeguards often have buckets of hot water at their stands, just for this purpose –  one more reason to swim at beaches with lifeguards.

Dr. Richard Clark, director of the division of toxicology at UC San Diego Medical Center, recommends soaking the injured area for about 15 minutes. The ideal water temperature is warmer than a hot tub (104 degrees), but less than 114 degrees.

If you are still in a lot of pain after 15 minutes, he recommends seeing a doctor or going to an emergency room. At the doctor’s office, expect to have X-rays taken because, on rare occasions, part of the stinger can break off. You may also be given a tetanus shot.

Dr. Clark also often puts patients on antibiotics, not to treat the sting, but because of water-borne bacterial pathogens, the main worry being Vibrio, which can be present in coastal waters.

Why hot water? 

Dr. Clark says that the venom in the stingray is heat labile, meaning heat denatures and destroys the toxin that causes inflammation and pain.

Are all rays dangerous?

No, and the animals are not aggressive, either.

Most injuries in Southern California are from round rays, Lowe says. Small bat rays have also been known to sting people, though this is much less common.

What is the “sting” from?

A stingray’s stinger is coated in a venomous mucous sheath. 

The mucous sheath contains toxin cells that rupture upon impact, says Lowe, whose research has examined the topic. Grooves on the barb – a modified dermal scale – help with toxin delivery.

Why does it hurt so much?

Nobody really knows.

There is something about the venom that stimulates the pain receptors in our body, Dr. Clark says. The exact toxin is not yet well understood, but it’s likely a complex mixture of different chemicals, similar to the venom on the spines of scorpion fishes, which include most of the world’s venomous marine fishes.

Video: Round stingrays like this one will bury themselves in the sand in shallow water.
This makes it easy to step on one. Video by Catherine Courtier

Written by Christina S. Johnson (2012). Updated 2020

90,000 How long do the stitches heal after surgery?

Suture methods and types of materials used

Correctly applied seams are neat and smooth. The medical suture must slide and not additionally injure the damaged tissue. Significant quality criteria are also:

• extensibility;

• elasticity;

• strength;

• the ability to withstand loads without squeezing tissue;

• biocompatibility and inertness (suture material should not enter into a chemical reaction with tissues).

In addition, the material should not actively absorb moisture and swell. Absorbable materials should have a resorption time close to the healing time, which depends on many factors.

The doctor carries out the choice of threads for sutures depending on the tasks. The modern industry offers more than 30 types, including absorbable and non-absorbable, synthetic and natural, braided, twisted, single-layer and multi-layer, as well as different types of coatings.The same properties can be advantages and disadvantages in different cases.

At the same time, the requirements for threads in surgery differ significantly from the usual idea of ​​the quality of people who are not familiar with this science. So, smooth threads do not allow you to form a strong, reliable knot. Natural fibers, highly valued in other areas, carry the risk of an allergic reaction and infection.

Non-absorbable materials

This group includes silk, cotton, metal and synthetic threads.Silk is a durable and conditionally non-absorbable material, since over time, approximately in 12 months, the fiber is almost completely absorbed. When joining fabrics for a much shorter period, the silk suture is characterized by relatively high strength, ductility and reliability. However, the fiber provokes a marked immune response in the body and can serve as a reservoir for infection in a wound. Cotton is less durable and can provoke inflammation.

Metal, stainless steel, is extremely durable and does not contribute to the development of inflammation.It is most commonly used to connect tendons and in abdominal surgery. Synthetic fibers have the best characteristics. They combine strength and inertia. They are most often used to connect soft tissues.

Absorbable suture materials

Natural absorbable materials made from purified connective tissue have not received widespread use, since they do not differ in strength, they tend to provoke tissue reactions and inflammation.It is also inconvenient to use. It is almost impossible to predict the period of their resorption in advance.

Synthetic threads have a predictable resorption time and do not cause tissue reactions, however, they have limited application. They are not used when the constant (constant) strength of the seams is important.

Surgical suture methods

Sutures are classified as primary and secondary. The latter are used to strengthen the primary, as a rule, with a large number of wound granulations.Secondary sutures are also placed to relieve the wound. In addition, the seams are subdivided into nodal, continuous, etc.

The timing of the healing of surgical sutures

The physician always strives to provide healing by primary intention. However, not everything depends on the professionalism of the doctor. With a successful course (no suppuration, minimal swelling), the process goes through the following healing stages:

• The period of the inflammatory response.It usually lasts 5 days. During this time, the body’s immune system destroys germs, destroyed cells and foreign particles. At this stage, only the sutures hold the edges of the wound.

• Polyiferation period. Lasts 14 days. At this time, there is an active formation of granulation tissue due to the production of fibrin and collagen, which fixes the edges of the wound.

• Ripening period. Lasts until healing.At this stage, connective tissue is actively formed.

The doctor will remove the stitches when the wound heals and the need for additional edge support is gone. As a rule, the stitches applied in the area of ​​the face and neck are removed in the rock up to 5 days, in the area of ​​the trunk and limbs – up to 10 days.

Factors affecting the healing time

The timing of healing depends on many factors, and first of all it is individual, especially of the organism, the features of the incision performed, the type of suture materials used, as well as compliance with the rules of care during the rehabilitation period.Ingestion of various substances, pollution and the presence of severe chronic diseases such as diabetes can significantly lengthen the recovery period. What matters is the total weight of the patient, the state of health during the rehabilitation period.

Care of seams

Suture care is carried out on the basis of the recommendations given by the doctor. As a rule, the wound needs to be treated daily with antiseptics and drugs that accelerate tissue regeneration. In the postoperative period, it is recommended to avoid physical activity, alcohol consumption, adhere to the diet recommended by the doctor.

If the seam has come apart, you should immediately consult a doctor. Soreness of the seams during the recovery period is considered normal. Therefore, in the early days, pain relievers are often prescribed. If intense pain persists for a long period and you suspect an infection, you should consult a doctor for advice.

90,000 Studying the types of tissue damage when using three electrosurgical technologies and ways of their healing

Study of the types of tissue damage when using three electrosurgical technologies and ways of their healing

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Authors: G. Muhlfay, K. Croat, Tirgu Mures University of Medicine and Pharmacology (Romania)

Abstract

Over the past decades, technical progress in the field of medical technology has moved towards the creation of new electrosurgical techniques. The data on the use of various technologies are contradictory: high-frequency electrosurgery (EHHF cauterization), laser technology and radio wave surgery pushed us towards a more detailed study of the histopathogenic structure and comparison of the wound healing processes inflicted by each of the three electrosurgical devices.

The experimental study was based on the study of wounds inflicted on laboratory animals by electrosurgical devices.
Twelve white Wistar rats were used as laboratory animals. Wounds were inflicted under general intravenous anesthesia with Xylazine and Ketamine. The wounds were inflicted laterally in the dorsal region using a surgical laser, high-frequency surgical apparatus, and a radiofrequency generator.
The collection of histological samples from wounds was carried out on the first, third, fifth and seventh days of the experiment.Samples were transferred for pathological and histological examination. Comparative analyzes of the first two phases of tissue healing, damaged by three electrosurgical methods, were carried out.
Described histopathogenic changes that occurred with the epidermis, dermal layer, hypodermis and also subcutaneous soft tissues in all three types of damage.
EHHF statistically remains the most widely used method, despite the obvious disadvantages of the method compared to the other two.Laser and radio frequency technologies refer to technologies with precise and metered application of energy and are used in various fields of surgery.

Introduction

Over the past decades, technological progress in the field of medical technology has moved towards the creation of new electrosurgical techniques, with the ultimate goal of improving the postoperative period, reducing bed days and leading to more physiological tissue recovery after surgical interventions.
The first step in the development of electrosurgical devices was represented by the development of monopolar and later bipolar technologies.
Energy-rich medical technologies make it possible to carry out interventions with the least blood loss and with a smaller area of ​​damage and is associated with thermal damage not only to the dissected tissues, but also to the underlying anatomical structures.
New technologies that began to be used in surgery were radiofrequency surgery, laser and high-frequency tissue ablation, which significantly improved surgical technique by reducing thermal damage to tissues during dissection and helped to achieve effective controlled hemostasis.
The fairly high level of the use of all kinds of technologies in surgery pushed us to the production of experimental tests conducted in order to study the healing process of postoperative wounds inflicted by three types of devices that are widely used in ophthalmology, ENT practice, endocrine surgery, general and plastic surgery.

Materials and Methods

In the experiment, the processes of healing of wounds inflicted by electrosurgical devices on the tissues of laboratory animals were studied, which were 12 white Wistar rats, aged 10 to 12 months from the vivarium of the University of Medicine and Pharmacology Tirgu Mures (Romania).
Due to the fact that infection of the wounds could affect the test results, rats were taken as laboratory animals because of their high resistance to infection.
The study was carried out in accordance with the provisions of No. 10/18. 02. 2009 Ethical Scientific Committee of the University of Medicine and Pharmacology Tirgu Mures (Romania).
The wounds were inflicted under general intravenous anesthesia with Xylazine and Ketamine in the following doses: Xylazine 0.5 mg and Ketamine 8 mg.

Info: Skin structure
The skin consists of three main layers: the epidermis, the skin itself and the hypodermis or subcutaneous layer.

The epidermis is the outermost layer of the skin. It is the basal layer that forms new cells by dividing and thus is made up of cell layers.
New cells gradually move from the inside to the surface. This movement takes one to two months. Gradually moving to the surface, cells die off due to thinning and keratisation.
The outer layer of the epidermis is a layer of dead cells that constantly slough off due to the friction of the layers.The keratinized layers and oil from the sweat glands help the skin to be waterproof.
The skin itself (or dermis) is the middle layer of the skin. It consists of:

• Connective tissue.
• Elastic fibers that contribute to the elasticity and contractility of the skin.
• Capillaries – thin blood vessels that are supplied with blood through arterioles.
• Muscles that lift the hair (lift the hairline).
• Sensory cells – cells responsible for touch, pressure, heat, cold and pain.
• Nerve fibers that activate muscles and glands and carry information from sensitive cells to the brain.
• Melanin-producing pigment cells – black pigment.
• Sweat glands, which open on the surface in the form of pores.
• Hair follicles – holes in the epidermis through which hair grows.
• Sebaceous glands, which produce a grease that cleanses and protects hair follicles from dust and bacteria and ensures the skin’s moisture resistance.

The hypodermal layer , also known as the subcutaneous layer, is the last layer of the skin. It is essentially the fatty layer of the lower layer of the skin. The thickness of this layer varies depending on the location and individual characteristics of the person. Adipose tissue stores act as isolation and are a source of energy in case of insufficient nutrition of the body.

Info: Skin wound healing process

The process is accompanied by predictable phases: inflammation, tissue proliferation (growth), regeneration – the process of filling the wound surface with new tissue.

1. Inflammation. During this phase, dead and damaged cells are cleared from the wound channel along with bacteria, pathogens and dead tissue fragments. This is due to the process of phagocytosis, during which white blood particles “eat” non-viable tissue sites, melting them.Platelet growth factor develops in the postoperative wound, which leads to cell migration and division during the proliferative phase.
2. During the proliferative phase , new granulation tissue is rebuilt with the formation of a collagen and extracellular matrix, in which new networks of blood vessels are intensively developed. This process is called angiogenesis. Healthy granulation tissue, depending on the number of fibroblasts, receives a sufficient amount of oxygen and nutrients from the blood vessels.Healthy granulation tissue consists of granules and intermittent tissue texture. This makes it difficult to bleed and is pink or red in color. Ultimately, the bottom of the wound canal is lined with epithelial cells and the process is called “epithelialization”.
3. Regeneration . During the tissue remodeling process, collagen fibers are positioned along the tension lines of tissue and cellular structures that are no longer needed and removed with the natural process of cell death.

G. Mukhvey et al. Studied two phases of postoperative wound healing: inflammatory and proliferative. The authors have shown convincingly that radiofrequency exposure to tissue, when destroyed, produces much less thermal damage and thermal dissemination. Thus, it was proved that the proliferative phase begins much earlier if the incision is made by an apparatus of the type and the proliferation of new cells begins approximately from the third day after the application of the surgical wound.In the case of using a laser, this period is 5 days, and when using EHHF, the stage of proliferation does not begin even after the seventh day after injury.

Conclusion

RF generator CURIS and skin wound healing process.

Research Questions: Is there a difference in the rate of healing of surgical wounds inflicted with three different electrosurgical devices?

Research method

The results of using () and 2 surgical lasers were compared.
Laboratory rats were used to study damage to biological tissues.
Histopathological examination was carried out on the basis of a study of biopsies when making incisions with three investigated devices for different periods of time.

• On the first day of the experiment, the thermal effect on tissues in the wound channel and surrounding tissues was studied.
• Days 3-5 and 7: Postoperative wound healing was assessed.

The tissue cutting power was set as follows:

• CURIS -10W
• Erbe ICC50 -35W
• CP2 laser -2.5W

Results:

Day 1

• When using CURIS RF for tissue incision, there was less thermal damage to tissues, fewer necrotic tissues, and less inflammation of the surrounding tissues.
• When using a radio frequency generator (CURIS), the basal layers were not damaged, which led to the subsequent faster healing of the postoperative wound.
• When using EHHF and a laser, necrotic detachment and deep thermal damage to the layers of the skin are much more pronounced.

Day 3

• With the use of the RF generator, an intensive healing process of the postoperative wound (proliferation phase) began.
• When using a laser and especially EHHF (Erbe), the inflammatory reaction is most pronounced due to a significant amount of necrotic fragments in the tissue.

Day 5

• The laser wound began to heal with tissue re-epithelialization.
• The wound inflicted by the EHHF gapes, an obvious delay in the epithelialization phase.

Day 7

• The wound inflicted by a radio frequency generator demonstrates the completion of the tissue re-epitalization process.
• Laser wound during re-epithelialization.
• The wound caused by EHHF did not close, it remains with elements of a pronounced inflammatory reaction.

Conclusion

RF Generator CURIS provides faster wound healing and tissue repair starts much earlier than comparable devices.

Copyright protected by the Law of the Russian Federation of July 9, 1993 No.5351-I On Copyright and Related Rights. Any copying, full or partial reproduction of the information contained in this article is prohibited without written permission.

Articles on radiosurgery

How to properly handle wounds – on the website Pharmacy

Scratches, abrasions, cuts, lacerations – all this we can “get” even in our own apartments. And at the dacha, the risk grows at times. At the height of the season, we talk about how to properly treat wounds and when to contact a doctor.

So, let’s start with when exactly you need to seek the help of specialists:

1. When a small child is hurt.

2. When biting animals – not only dogs, but also foxes, hedgehogs, rodents. This is very important, since the animal can be a carrier of rabies, and only timely medical assistance can save the victim.

3. If the wound is from a dirty or rusty object and you have not had a tetanus shot in the past 5 years.

4. For cuts and lacerations, if the depth of the wound is deeper or more than 1.5 cm.

5. If there is bleeding of a pulsating nature.

6. If there are wounds and deep cuts on the hands, face, neck, head.

7. When the blood does not stop for more than 20 minutes.

8. When there are several wounds.

9. If after injury the high temperature has risen and persists.

ten.If the person has dizziness and nausea.

11. If there is inflammation, the wound does not heal well.

How to treat wounds

Prepare for wound care: wash your hands and treat them with hand sanitizer, alcohol solution, or alcohol wipe.

Depending on the type of wound, the procedure may differ slightly, but in general it is as follows:

Examine the wound, determine what its nature and how severe the damage

· Try to stop the bleeding.

Wash the wound with hydrogen peroxide (3%), chlorhexidine or furacilin solution (0.5%) or pink potassium permanganate solution (it must be filtered through gauze). Dry the wound with a tissue.

· Treat the skin around the wound with an antiseptic and apply a sterile dressing. Do not forget to bandage afterwards.

· Decide if you need to see a doctor. Drink a pain reliever if needed.

Almost all “household” wounds are dirty, so it is very important to clean the wound, if possible, without touching it with your hands.A clean wound will heal faster and help avoid complications.

Only the edges of the wound need to be treated. You cannot pour alcohol, iodine, greenery, etc. into it, otherwise you will burn the tissue, and as a result, instead of a small scar, a huge scar may appear at the site of the wound.

If the wound is deep, stop the bleeding with a pressure bandage and see a doctor immediately. Just remember that the pressure bandage should not be applied for more than half an hour.

On cuts and lacerations, you can apply the antibacterial and wound-healing ointment Levomekol, and a sterile bandage on top.This dressing should be changed twice a day. It is important to keep the wound and dressings clean.

If the wound does not heal for a long time, it is most often due to an infection. This can be determined by the fact that the wound hurts, gets wet, festers. In this case, you need to see a doctor.

To help wounds heal faster, it is recommended to eat more meat, vegetables and fruits and generally try to eat right, get enough sleep, do not drink alcohol and do not smoke.