The usefulness of a skin biopsy punch to remove sea urchin spines

Abstract

The usefulness of a skin biopsy punch to remove sea urchin spinesa ns_5296 383..390 Sea urchins are spiny marine animals commonly found along the coastline in both tropical and tempered waters. There are hundreds of species. All are roughly spherical in shape and characterized by spines made up of fragile calcium carbonate crystals. On contact and penetration of the skin, the spines often break, resulting in deposition of foreign material in the cutis or subcutaneous tissues. The recent development of sea urchin aquaculture has resulted in an increasing number of people at risk for injuries, in addition to those traditionally injured during leisure or marine sports activities. Painful wounds with local inflammation or infection are commonly seen, sometimes taking considerable time to heal. Complications, such as arthritis or granuloma formation related to the foreign-body reaction, can result in disabling conditions. 1 Early excision of the spines is favoured, rather than waiting for spontaneous recovery. A number of different methods have been described, including advanced techniques for surgical removal. 2-4 We introduce a new and simple technique to remove the spines by a dermal biopsy punch.A 25-year-old man was referred to our outpatient clinic, after having stepped on a green sea urchin (Strongylocentrotus drobachiensis) the previous day. On admission, multiple remnants of sea urchin spines were seen in the skin on the plantar side of his right heel.The area was cleaned and anesthetized with combined lidocain 10 mg/mL and epinephrine 5 mg/mL (Xylocain, AstraZeneca, Oslo, Norway). A biopsy punch with a diameter of 2 mm (Miltex, Inc., York, PA, USA) was used to cut out each spine including a small piece of surrounding dermal tissue to support the fragile remnants of calcium carbonate. Further crushing of the fragile material was thereby prevented and the spines could be completely removed using forceps and scissors (Fig. 1). There were no post-operative complications and the wounds healed uneventfully within the following 2 weeks.We think that a dermal biopsy punch, commonly found in most medical offices, is a simple and handy tool to solve this problem and thereby reducing the morbidity of the patient.Letters to the editor 383

Removal of Sea Urchin Spines Using Erbıum-Doped Yttrium Aluminum Garnet Ablatıon

“…The initial injury results in pain, *All authors are affiliated with the Department of Dermatology, Okmeydani Research and Training Hospital, Istanbul, Turkey bleeding, erythema, edema, burning, local myalgia, and inflammation at the site of injury even if the spines are nonpoisonous. Nassab et al 6 described an elliptical incision method, whereas Sjoberg et al 5 recommended skin punch biopsy for the removal of spines, but these surgical techniques are difficult, and local anesthesia is needed, especially with multiple spine penetrations. Death has already been reported after an injury of flower sea urchin spine.…”

“…If these methods do not work, surgical excision may be necessary. Nassab et al 6 described an elliptical incision method, whereas Sjoberg et al 5 recommended skin punch biopsy for the removal of spines, but these surgical techniques are difficult, and local anesthesia is needed, especially with multiple spine penetrations. Upon using the Er:YAG laser for management of spine penetration for the first time, Bö er et al 1 stated that the remnant spines were destroyed, leaving crater lesions after laser ablation.…”

“…[1][2][3][4] For this reason, early excision of the spines is indicated, rather than waiting for spontaneous recovery. 5,6 Here, we report a case of penetration injury caused by sea urchin spine treated using erbium-doped yttrium aluminum garnet (Er:YAG) laser ablation.…”

Site Selection

“…[31] Sjoberg et al exposed that a dermal biopsy punch, commonly found in most medical offices, is a simple and handy tool to solve this problem and thereby reducing the morbidity of the patient [31] In these cases, site selection is exactly where the urchin spine is located.…”

Use of dermoscopy after punch removal of a veiled sea urchin spine

“…Sea urchin spines are composed of fragile calcium carbonate crystals. 2 However, radiography is not highly reliable, and intraoperative radiographic application is impossible in outpatient settings. 3 In such cases, intraoperative dermoscopy may be performed.…”