Brown recluse spider bites of the upper extremity.

Brown recluse spider bites may cause painful, necrotic, slow-healing wounds. When these bites involve the hand and upper extremity, they can also create severe functional deficits and long-term disability. We reviewed an 11-year experience with brown recluse bites to the hand and upper extremity. Data from patients (n = 31) indicated a 20% incidence of functional complications (n = 6) unless conservative wound management, dapsone, and antibiotics were used. Delayed surgical excision was preferable until wounds were free from active inflammation. Painful, recurrent wound breakdown and hand dysfunction were more common with early surgical excision. These complications were successfully treated with steroids, sympathetic blockade, and early aggressive physical therapy.