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Table 1: The admission of patients with snakebite injuries during the period of October 2012-October 2013
Year Month In patient snake bite ASV Death Referred to plastic surgery
Adult Pediatrics given Pediatrics Adult
2012 October 23 3 10 1 1 4
2012 November 16 2 8 2 0 1
2013 December 15 5 5 1 1 1
2013 January 10 1 3 1 0 2
2013 February 16 2 9 2 0 4
2013 March 9 4 7 2 0 1
2013 April 11 7 10 1 1 4
2013 May 44 8 34 3 1 5
2013 June 119 2 22 0 1 4
2013 July 22 2 20 0 0 4
2013 August 27 1 20 2 1 5
2013 September 19 3 15 0 0 2
2013 October 20 4 11 2 1 3
Total 13 months 351 44 174 17 7 40
Number of patients 395 47
ASV: anti-snake venom
Table 2: The number of pediatric and adult patients
referred to plastic surgery department with snake
bite injuries
Cellulitis Compartment Surgery
syndrome
Upper Lower Upper Lower Upper Lower
limb limb limb limb limb limb
n 6 17 2 5 7 10
Paediatrics 1 1 0 1 1 2
Adult 5 16 2 4 6 8
Total 23 7 17
bleeding, hypotension, cardiotoxicity, and nephrotoxicity
that require immediate medical attention. Local signs
such as tissue edema, compartment syndrome, and
tissue necrosis increases the morbidity and may result in
fasciotomy or amputation of the involved extremity. [7,8] Figure 1: (a) Compartment syndrome right leg and foot lateral view;
(b) compartment syndrome right leg and foot medial view; (c) six
sessions following hyperbaric oxygenation therapy
ASV administration can reduce progression of the initial and tenderness in the envenomated extremity, mimicking
tissue damage, but it cannot reverse local tissue damage
such as tissue edema, inflammation, compartment the initial signs of compartment syndrome. However, true
[10]
[7]
syndrome, and necrosis. Although inflammation induced compartment syndrome is much less common. In a case
[11]
by snake envenomation often mimics infection, true series conducted by Tanen et al., only 8/236 (3.4%) of
bacterial cellulitis is uncommon, and only affects 3% of patients received a fasciotomy or digital dermotomy for
snakebites. Tissues at the point of envenomation may compartment syndrome. Measurement of compartment
[9]
be nonviable regardless of intervention. The adjacent pressures prior to fasciotomy is always recommended.
zone consists of variably injured tissues that may Recent literature indicates that an increase of
recover if the process of inflammation is reduced. Most intracompartmental pressures of up to 30-45 mmHg is
therapeutic maneuvers are focused on this penumbra an absolute indication for fasciotomy. [12,13] Unfortunately,
of tissue, in an attempt to maximize recovery of the injured measurement of intracompartmental pressure is not
marginal tissue. Finally, an outer zone of minimally always possible in a number of medical centers in India,
injured tissues that are not subject to primary injury and most of the diagnoses of compartment syndrome are
may be at risk from the processes of secondary injury made on clinical grounds alone. Anz et al. reported that
[14]
resulting from the delayed, physiological inflammatory 21.2% of all poisonous snake bites involve fingers. Fingers
responses to snake bite injury. Occasionally, the quantity have small compartments with its small diameters,
of tissue loss and destruction caused by secondary injury can and the elastic limit of the skin can be rapidly reached.
dwarf the actual loss from the primary snakebite. Hence, Compartment pressure measurement may not be feasible
there is a need for modalities that impede the progress
of inflammation, preserve marginal tissue at risk, and in cases of digital envenomation, and the diagnosis of
prevent ischemic advancement of the injured tissue. compartment syndrome can only be made on clinical
grounds. Some authors support early fasciotomy in the
[15]
When compartment syndrome occurs in snakebite injuries, treatment of all cases of snake bite envenomation. [15,16]
there is controversy as to whether or not fasciotomy is Fasciotomies are not without complication, and may result
required. Snakebite injuries can produce pain, swelling, in disfiguring scars, contractures, nerve damage, leading
induration, paresthesias, color changes, absent pulses, to significantly lengthening of treatment. [7]
Plast Aesthet Res || Vol 3 || Issue 2 || Feb 29, 2016 61