It’s Never Really a Spider Bite…

I realize the title to this post is somewhat cryptic.  This is a day where I talk about a less glamorous part of Plastic Surgery.  Welcome to the wound care side, my friends.  Remember that Plastic Surgeons are, after all, the tissue experts.  This is why we can manipulate skin and cartilage to make a better nose, and why we can move a stomach muscle up to make a new breast.  It’s also what makes us the wound care experts.  If other surgeons have a wound they can’t close, they call a Plastic Surgeon.

All General Surgeons deal with generalized skin infections, ranging from a localized abscess to the widely publicized “flesh-eating bacteria” (necrotizing fasciitis).  So any physician who did a year of general surgery (which is most surgical specialties, by the way) will tell you: if a patient thinks he or she has a spider bite, it’s never really a spider.  Unless of course the patient saw the actual spider, which very rarely happens.  What a “spider bite” virtually always turns out to be is a staphylococcus infection, causing a cellulitis and possibly an abscess.  It may start from a microscopic break in the skin, or an inflammation of a hair follicle.  Because there is no cut or injury the person remembers, he or she chalks it up to a spider bite.

So what should you do if this happens to you?  First, clean the area thoroughly with soap and water.  Then take a permanent marker and outline where the redness stops.  If the affected area is on an arm or a leg, elevating it and wrapping it gently with an ACE can help the swelling.  Cleansing it gently twice a day with soap and water, and applying antibiotic ointment such as neosporin or polysporin may help.  Here’s when to see a doctor:

• the redness spreads outside the mark you drew
• you have drainage that looks like pus
• the area isn’t getting better over 2-3 days

And here is when you should go to the emergency room:

• redness spreading outside the mark you drew within a matter of hours
• you have a fever of 101 or higher
• you have pain and tenderness outside the red area

So do people ever get bitten by a an actual spider?  Absolutely.  Here in the midwest, it’s usually a Brown Recluse.  These bites can lead to nasty wounds, so these patients are often referred to – you guessed it – Plastic Surgeons.