The epidemiology, evaluation, and management of stingray injuries.

A descriptive analysis and review of the world's salient scientific literature on stingray injuries was conducted in light of recent high-profile cases of fatal and near-fatal thoracic stingray injuries to guide clinicians in evaluating and managing stingray injuries. Data was extracted from observational and longitudinal studies over the period, 1950-2006, to permit (1) a stratification of stingray injuries as bites, penetrating lacerations with and without envenoming, and combinations of deeply penetrating and envenoming wounds; and (2) an assessment of new management strategies for thoracoabdominal penetrating trauma and non-healing, necrotic stingray wounds. Unlike their Chondrichthyes classmates, the sharks, stingrays are docile and non-aggressive; and will not attack with their spined tails, unless provoked. Although some occupations are predisposed to stingray injuries, most stingray injuries can be avoided by observing seafloors and adopting simple practices when wading, swimming, diving, or fishing in temperate oceans and some tropical freshwater river systems. All stingray injuries should be managed initially with wound irrigation to dislodge retained spine fragments and envenoming tissues and warm water immersion to inactivate heat-labile toxins.