The Role of the plastic surgeon in spider bites: case series and Italian national survey on diagnosis and treatment

Introduction. Spider bite injuries are an emerging topic of interest worldwide. Although the incidence of cases appears to be rising, European literature provides only limited insight. This study aims to characterize suspected spider bites in Italy, highlight the role of the plastic surgeon in treatment, and lay the groundwork for future research. Medically significant spiders in Italy include Loxosceles rufescens, Latrodectus tredecimguttatus, and Cheiracanthium punctorium. Differential diagnosis, both in identifying the spider and in interpreting the clinical presentation of unverified cases, is complex. Methods. A 10-question survey was developed to investigate the epidemiological, diagnostic, and therapeutic aspects of spider bites and was distributed to members of the Italian Society of Plastic, Reconstructive, and Aesthetic Surgery. Additionally, a case series of four moderate-to-severe suspected spider bite injuries is described. Results. The survey, involving 40 plastic surgeons, revealed that cases are rare and spider identification is often uncertain. Within a year, 47.5% of respondents reported no systemic symptom cases, and 45% treated only one patient. Antibiotics were the most commonly used medications, and biopsy was deemed the most useful diagnostic tool. Enzymatic or autolytic debridement was performed in 66.7% of cases, while immediate reconstruction was rare. The case series included one secondary-intention healing, one skin graft reconstruction, and two free flap reconstructions. Conclusions. Three patients in the case series experienced further necrosis development within 5 weeks of onset. Delayed reconstruction after 5 weeks appears to be advisable. Establishing a national database in collaboration with arachnologists could enhance future studies and guidelines development.