Skin and Soft Tissue Necrosis Following Hymenoptera Sting Ug˘ur Koc ¸er, Yig˘it O ¨ zer Tiftikciog˘lu, Hasan Mete Aksoy, and O ¨ nder Karaaslan Abstract Background: All kinds of bees, wasps, and hornets are members of the hymenoptera order. Local hypersensitivity reactions after bee stings are very common and well studied. However, tissue necroses following untreated bee stings are extremely rare and they are not well documented. Objective: Two extremely rare cases of extensive skin and soft tissue necrosis following hymenoptera stings are presented. Current literature and treatment options are dis- cussed. Conclusions: Local skin reactions following bee stings may result in severe compli- cations such as tissue necrosis if left untreated. Skin grafting following surgical de- bridement is an adequate and practical treatment modality for such cases. Sommaire Ante´ce´dents: Les abeilles, les gue ˆpes et les frelons font tous partie de la famille des hyme ´nopte `res. Les re ´actions d’hypersensibilite ´ locales a ` la suite d’une piqu ˆ re sont tre `s fre ´quentes et ont fait l’objet de nombreuses e ´tudes. Ne ´anmoins, les ne ´croses tissulaires cause ´es par des piqu ˆ res non traite ´es sont extre ˆmement rares et ne sont pas bien docu- mente ´es. Objectif: On pre ´sente deux cas extre ˆmement rares de ne ´croses cutane ´es et tissulaires cause ´es par des piqu ˆ res d’hyme ´nopte `res. Les publications actuelles et les options de traitement sont discute ´es. Conclusion: Les re ´actions cutane ´es locales a ` la suite de piqu ˆ res d’abeilles non traite ´es peuvent causer des complications graves, telles que les ne ´croses tissulaires. Une greffe de la peau a ` la suite d’un parage chirurgical repre ´sente un traitement pratique et ade ´quat dans de tels cas. H ymenoptera stings and related allergic problems are common and well studied. Bees, wasps, and hornets are members of the order Hymenoptera and account for the majority of anaphylactic reactions to venomous ani- mals and insects in the United States. 1 Members of this order are found commonly in nature and, especially bee populations, are also kept for commercial purposes. As a result, hymenoptera stings are very common conditions and they usually heal without any complications follow- ing minimal treatment. Hymenoptera venoms contain complex mixtures of allergic proteins, active antigens, and peptides. 2 Honey- bee venom is known to contain phospholipase A (the major allergen), hyaluronidase, mellitin, and apamin. Also included are a number of vasoactive substances in- cluding histamine, norepinephrine, dopamine, and mast cell degranulation peptides. 2 Although the ingre- dients of hymenoptera venoms are well known, the exact mechanisms of their toxic and allergic reactions are not defined. Symptoms following bee stings may be due to im- mediate or delayed reactions. Immediate reactions, which occur within two hours, may be subdivided into local and systemic reactions, which may be toxic or allergic and are well documented. Immediate local reactions usually present with erythema, edema, and transient pain or pruritis that subsides within a few hours. Reactions Plastic and Reconstructive Surgery Clinic, Ankara Training and Research Hospital, Ankara, Turkey Online publication: 27 November 2002 Correspondence to: Ug ˘ur Koc ¸er, Mes ˇrutiyet Cad. 17/12, 06640 Kızılay, An- kara, Turkey, E-mail: ygit@hotmail.com DOI: 10.1007/s10227-002-0163-9 J Cutan Med Surg 2003; 133–135 133