Modern Plastic Surgery, 2012, 2, 97-98
http://dx.doi.org/10.4236/mps.2012.24023 Published Online October 2012 (http://www.SciRP.org/journal/mps) 97
Surgical Removal of Numerous Foreign Bodies from the
Foot Caused by Sea Urchin Spines
Mahmoud A. Hafez*, Ahmed Mounir Al-Dars
The Orthopaedic Department, October 6 University, Cairo, Egy p t.
Received June 29th, 2012; revised July 31st, 2012; accepted August 30th, 2012
ABSTRACT
Injury from sea urchin spines is not rare, especially during summer holidays in the sea side. Failure to remove these
spines or inability to remove them completely can lead to long-term squeal of pain and impaired function. Treatment
methods include alternative medicine, LASER and surgery. We describe the surgical removal of 102 sea urchin spines
from the foot of a 36-year-old man. The wounds healed completely. Although, he initially complained of a mild dis-
comfort on weight bearing, the symptoms disappeared 2 weeks later.
Keywords: Sea-Urchin; Foreign Body; Surgical Technique; Infection; Foot
1. Introduction
Sea urchins belong to the phylum Echinodermata, class
Echinoidea. They inh abit oceans and they do not exist in
fresh water. Their spines are made of CaCO3 crystals that
make them radio-opaque, however the radio-opacity may
vanish if the calcium is absorbed by the host tissues.
Therefore, early detection will allow radiological visu-
alization. The spines can cause local irritation, infection,
foreign body granulomas, chronic synovitis and arthritis,
with long term morbidity [1].
Injury from sea urchin spines is not rare, especially
during summer holidays in the sea side. Failure to re-
move these spines or inability to remove them com-
pletely can lead to long-term sequelae of pain and im-
paired function. Treatment methods include alternative
medicine, LASER and surgery. We describe the surgical
removal of 102 sea urchin spines from the foot of a 36-
year-old man.
2. Patients and Methods
A 36-year-old man stepped on a sea urchin during his
holidays in the Mediterranean Sea. A first attempt of
removal of the spines by a local doctor was fruitless. He
presented to the orthopaedic department in our hospital
five days after the injury. His right heel showed numer-
ous small foreign bodies (Figure 1), some of them were
prominent and others appeared as black spots. There was
an evidence of local infection in two small areas, two
centimetres in diameter each, which were associated with
blisters. On further enquiry, these foreign bodies were
noted to be sea u rchin spines. We opted for surgical treat-
ment.
Surgery was done under general anaesthesia with the
patient positioned in prone under tourniquet control. A
hand surgical instrument set was used, including; fine
curved forceps, non-toothed forceps, skin-hook, and a
size 15 blade (Figure 2). Extra caution was needed while
holding and extracting the spines because they are thin
and fragile. The fine curved forceps were used to push
the skin deeper, around the spine, in order to make the
spine more prominent. A skin-hook was also used to
withdraw the spine. Then, the extraction was completed
Figure 1. Right heal showing numerous See-Urchin spines.
The heal shows small foreign bodies, some of them were
prominent and others appeared as black spots.
*Corresponding a uthor.

Surgical Removal of Numerous Foreign Bodies from the Foot Caused by Sea Urchin Spines
98
Figure 2. Hand surgical instruments set. Instruments set
including: fine curved forceps, non-toothed forceps, skin-
hook, and a size 15 blade.
Figure 3. Removed foreign bodies. The foreign bodies were
counted as 102 including separated spines and buried
spines.
by gently using the either forceps. For the completely
buried spines, a small incision (0.5 cm) was made over
the black spot and then, a skin hook was used to with-
draw the spine as described above. The removal was
easier in the infected areas. It seemed that the blistering
resulted in partial withdrawal o f the spines from the deep
tissues. Complete excision of these blisters resulted in
easy removal of 60 spines. The time of surgery was 75
minutes.
3. Result
All foreign bodies were removed and we counted 102
spines (Figure 3). The patient had no postoperative
complications and he was discharged home the day after.
The wounds healed completely although he initially
complained of a mild discomfort on weight bearing,
hich disappeared at the last follow up, two weeks later.
The patient did not turn up in the later follow up appoint-
ments.
w
4. Discussion
Sea urchin spines can cause local irritation, infection,
foreign body granulomas. When they penetrate the der-
mis (or sub cutis). Newmeyer [2] reported that infection
could be due to the effect of their toxins, epithelial cov-
ering and any contamination from the water in which the
injury occurred. Removal of sea urchin spines is not
easy as the spines are small and they can easily break.
Several cases have been reported, describing different
techniques for removal. Falkenberg [3] reported a tech-
nique using alternative medicine by crushing the spines
in situ by stone then voiding fresh urine on the wound.
Burnett [4] reported the use of bolus ejection and Boer et
al. [5] reported the use of erbium: YAG LASER. New-
meyer [2] reported surgical removal of see urchin spines
from the hand.
The surgical technique we used is simple, aseptic, and
efficient and does not need sophisticated equipments.
The results were excellent and the spines could be re-
moved entirely even without radiological localisation.
Injury from sea urchin spines can cause pain and dis-
ability if left untreated. Awareness of the nature of this
injury and modalities of treatment is important to emer-
gency physicians and surgeons. Surgical removal is
recommended especially when there is infection. Su rgery
should be done under general anaesthesia, in theatre. The
surgeon should be prepared for a long and tedious task.
Fine instruments, good theatre light, tourniquet and sur-
gical loupe are invaluable.
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