History:
A 72-year-old female presented to our Emergency Department in Da Nang, Vietnam with a stingray barb impaled in her right hand. The barb had been given to her by a local fisherman and she kept it with a collection of shells. As she was cleaning the shelf on which it was displayed, the barb fell, and she reflexively attempted to catch it. With no more than the force of gravity, it went through her thenar eminence of her right hand.
Her tetanus vaccination was up to date.
Physical Evam:
Stingray barb entering the thenar eminence though the hand, with barb tip visible on the dorsal aspect of the hand (see figure 2). She was neurovascularly intact, with normal range of motion in all fingers.
Hospital Course:
Due their retro-serrated edges, stingray barbs can cause further trauma when pulled back out “against the grain”. Because the barb penetrated through to the volar aspect of the hand (see Figure 2), a decision was made remove the barb by continuing its trajectory through the hand. The proximal end of the barb was cut with a heavy Rongeur near its entry point on the palmar aspect of the hand. The entry and exit wounds were anaesthetized with 1% lidocaine with epinephrine. The exit wound was enlarged 2 mm on either side with an 11-blade scalpel. The tip of the barb was grasped forceps and the barb was easily extracted through the hand with minimal force. X-rays revealed no foreign-body fragments post-removal.
The puncture wound was then copiously irrigated with sterile saline solution. The entry and exit wounds were left open and covered with bacitracin ointment and a dry gauze dressing. The patient was then discharged home on Trimethoprim-Sulfamethoxazole (DS Bactrim) BID for 5 days. At 1 week follow-up there were no signs of infection. For more on the management on Stingray envenomation see this previous SM article.
