Around 10 debridement procedures and 5 reconstructive surgeries: the work of Dr. Borriello and the Ospedale del Mare team
A 68-year-old man, Alessandro, arrived at the Emergency Department of Ospedale del Mare in Naples during the night between June 26 and 27, 2025, in serious condition. Bitten by an insect, presumably a brown recluse spider, in the days prior, he presented with a swollen and reddened left lower limb, with blistering lesions and high fever. What appeared to be a seemingly harmless bite turned out to be a complex medical challenge that required months of treatment and numerous surgical procedures.
In the Emergency Department, Alessandro was immediately prescribed an urgent CT scan, performed promptly by the General Radiology department headed by Fabio Tamburro, which revealed hemorrhagic infarction — an accumulation of blood due to vessel rupture — in the subcutaneous tissues. The patient was admitted to the Complex Operating Unit of Emergency Medicine directed by Giovanna Guiotto, with a diagnosis of sepsis and necrotizing fasciitis of the left lower limb.
His general condition worsened rapidly with high fever and progression of the infection: extensive areas of soft tissue necrosis (skin and subcutaneous tissue) appeared on the left leg and thigh, from the root of the thigh down to the leg, with the development of septic arthritis of the knee that raised the prospect of limb amputation. Alessandro was transferred to the Intensive Care Unit, directed by Ciro Fittipaldi, in early July.
Alessandro was then taken in charge by the Departmental Simple Operating Unit of Plastic Surgery directed by Alfredo Borriello. Borriello and his team performed approximately 10 debridement procedures — progressive resection of necrotic tissue, wound lavage and application of negative pressure therapy — to stop the advance of the infection and create the conditions needed for reconstruction.
At the same time, the general conditions of sepsis and infection began to improve thanks to the teamwork with Marina Lugarà, infectious disease specialist at Ospedale del Mare, who managed to keep the sepsis under control with targeted, state-of-the-art therapies. The reconstructive pathway then began with approximately 5 procedures involving the application of latest-generation dermal matrices and skin grafts.
After a long hospitalization and 15 surgical procedures, Alessandro made a full recovery: he kept his left lower limb and can walk perfectly.
Dr. Borriello's work required a multi-phase approach, combining several reconstructive plastic surgery techniques:
Alessandro's case represents an exemplary instance of multidisciplinary collaboration in public healthcare. From Fabio Tamburro's General Radiology to Giovanna Guiotto's Emergency Medicine, from Ciro Fittipaldi's Intensive Care Unit to Alfredo Borriello's Plastic Surgery and Marina Lugarà's Infectious Disease department, every unit played a decisive role in saving the patient's limb and life.
"The men and women of ASL Napoli 1 Centro have once again been extraordinary — says Maria Corvino, Medical Director of the ASL — Thanks to their professionalism and competence, they treated a very complex clinical case in the best possible way. A healthcare excellence that provides answers to our fellow citizens every day."
"The Ospedale del Mare team is a multidisciplinary unit that worked together to save a patient's lower limb and life — declares Director General Gaetano Gubitosa — This result is the fruit of dedication and the ability to work together, putting the patient and their health at the center. I thank all the staff involved for their commitment and for the optimal result achieved."
If these symptoms appear after an insect bite, it is essential to go to the Emergency Department immediately. Timely medical intervention can make the difference between a full recovery and far more serious consequences.
This case confirms the role of Ospedale del Mare in Naples as a reference point for reconstructive plastic surgery and the treatment of complex surgical emergencies. Under Dr. Borriello's leadership, the Plastic Surgery Operating Unit tackles highly complex cases on a daily basis, from post-traumatic reconstructions to the management of severe skin lesions, with results that attest to the excellence of public healthcare in the Campania region.
This content is intended for informational and educational purposes only. It does not in any way replace professional medical advice, diagnosis, or treatment. For any medical questions or concerns, it is essential to consult your physician or a qualified specialist.
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