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Table 3: The number of pediatric and adult patients referred to plastic surgery department with snake bite injuries
subjected to surgical intervention
Age (years)/ Upper limb Lower limb Surgery
gender Pediatric Adult Pediatric Adult
22/male Right thumb Terminalization
28/female Right-hand dorsum Debridement and groin
flap cover
32/male Right index finger Terminalization
8/male Right foot dorsum Debridement and skin
grafting
50/male Right second toe Terminalization
45/male Right leg lower Debridement and ALT
3rd lateral aspect free tissue
transfer
25/male Left 4th toe Terminalization
7/male Left middle finger Terminalization
32/female Right index finger Debridement and cross
MPX level finger flap

10/male Left foot dorsum Debridement and skin
grafting
26/male Right foot dorsum Debridement and skin
grafting
34/female Right ring fingertip Debridement and cross
region finger flap

35/female Right foot dorsum Debridement and lateral
supramalleolar flap cover
22/male Left foot great toe Terminalization
47/male Left leg middle Debridement and skin
3rd lateral aspect grafting
32/male Left foot little toe Terminalization
27/female Right thumb dorsal Debridement and FDMA
aspect flap
ALT: anterolateral thigh; MPX: middle phalanx; FDMA: first dorsal metacarpal artery

Figure 3: (a) Soft tissue defect right leg and ankle region; (b) anterolateral
thigh free tissue transfer done for the soft tissue defect

Figure 2: (a) Day 1 following snake bite injury; (b) day 2 following later. We did not experience any complications related to
hyperbaric oxygenation therapy; (c) day 3 following hyperbaric HBO therapy in our series. It is difficult to be certain
oxygenation therapy; (d) day 5 following hyperbaric oxygenation therapy;
(e) wound following debridement and grafting whether in the absence of HBO our patients treated
with snake envenomation injuries would have progressed
HBO therapy may reduce the penumbra of cells at risk
for delayed necrosis and secondary ischemia in snakebite to compartment syndrome or tissue necrosis.
injury patients with early compartment syndrome,
[15]
breathing of 100% oxygen under increased ambient As the degree of cellulitis and its severity varied from
pressure prevents reperfusion injury, reduces tissue edema, patient to patient as did the timings of the referrals,
and reverses sublethal tissue damage. [15,16] Vasoconstriction there was no standardized starting point for HBO therapy.
reduces edema and tissue swelling while ensuring Six sessions are minimum given to attain a tangible
adequate oxygen delivery in snakebite wounds. decrease in swelling. Assessment of sensory loss may not
be possible in small children, and hence we determine
In our series, 23 patients were treated for cellulitis and the treatment endpoint based on the decrease in girth
7 patients for compartment syndrome. In our experience, of the limb and also the movement of the toes. HBO
HBO therapy is a helpful tool when there is an impending therapy after surgical debridement, skin grafting or flap
compartment syndrome that may require a fasciotomy reduces edema of the inflamed operation site. Hence, we
62 Plast Aesthet Res || Vol 3 || Issue 2 || Feb 29, 2016