Page 68 - Journal of Special Operations Medicine - Summer 2014

Figure 1 Preoperative appearance of the sea urchin wounds. Figure 3 Removing a large sea urchin spine with Adson-
Brown forceps after four passes with the laser.

Figure 4 Samples of several sea urchin spines that have been
removed from patients.

Figure 2 Computed tomography
scan with sagittal reconstruction
demonstrating retained sea urchin
spines posterior to L5.

skin changes and radiographic guidance. Additionally,
intradermal infiltration with 1% lidocaine/1:100,000
epinephrine solution was offered immediately before Figure 5 Wound appearance after laser ablation and spine
the procedure. removal is complete.

With use of a Sciton 2940-nm erbium:YAG laser (set to
ablate 50, 2mm spot size, 1Hz repetition rate), ablative
treatment was performed at each skin lesion, consist-
ing of multiple passes through the epidermis and dermis
.Each lesion required between two and six passes of the
laser, removing 0.2mm of tissue with each pass. This was
continued until the bases of the sea urchin spines were
easily visible and circumferentially free of soft tissue.
Adson-Brown forceps were used to grasp the freed base
of the sea urchin spine firmly, and gentle traction (with-
out torsion to avoid breaking the spines) was applied to
extract each spine (Figure 3). Seven spines were success-
fully removed, which that varied between 3 and 15mm
in length (Figure 4). After removal of all the spines, only follow-up, no lesion or scarring was visible on patient’s
small wounds were visible on the back (Figure 5). back and the patient was asymptomatic.

Petroleum jelly was applied to the wounds and they
were dressed with Telfa. The patient was instructed to Summary
wash the wounds and apply mupirocin ointment and Sea urchin injuries are common and represent a real risk
a clean dressing daily for the next 10 days. At 1-year to those operating in coastal waters. Initial management

58 Journal of Special Operations Medicine Volume 14, Edition 2/Summer 2014