독사 교상 환자에서의 음압요법: 예비보고

Vacuum Assisted Closure Therapy in Snake Bite Wound: Preliminary Report

  • 송우진 (순천향대학교 의과대학 성형외과학교실) ;
  • 최환준 (순천향대학교 의과대학 성형외과학교실) ;
  • 강상규 (순천향대학교 의과대학 성형외과학교실)
  • Song, Woo-Jin (Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University) ;
  • Choi, Hwan-Jun (Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University) ;
  • Kang, Sang-Gue (Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University)
  • 투고 : 2010.09.14
  • 심사 : 2010.11.17
  • 발행 : 2011.01.10

초록

Purpose: Vaccum-assisted closure (VAC) has rapidly evolved into a widely accepted treatment of contaminated wounds, envenomations, infiltrations, and wound complications. This results in a sealed, moist environment where tissue is given the opportunity to survive as edema is removed and perfusion is increased. Many plastic surgeons now place a VAC device directly over the fasciotomy site at the time of the initial procedure. Large amounts of the fluid are withdrawn, and fasciotomies can be closed primarily sooner. This study was designed to observe the effect of VAC in preventing complications in snake bitten hands. Methods: In our study of three cases of snake bite, three of them underwent the VAC treatment & fasciotomy of the wound in the hand. This cases, the posterior compartment of the hand was bitten for a few days, releasing incisions were made of the posterior hand and 125 mmHg of continuous vacuum was applied to fasciomy incision site and the biting wound. The dressings were changed three times per week. Results: Our study examining the effects of applied vacuum in preventing snake bite wounds showed that the incidence of tissue necrosis and compartment syndrome was significantly lower for vacuum-treated wounds than for conservative wounds. Serum myoglobin, CK-MB, and CPK levels measured after fasciotomy incision were significantly decreased. We obtained satisfactory results from early dorsal fasciotomy, drainage of the edema with the VAC system, and then primary closure. The postoperative course was uneventful. Conclusion: Envenomation is a term implying that sufficient venom has been introduced into the body to cause either local signs at the site of the bite and/or systemic signs. Use of the vacuum-assisted closure device in snake bite can result in a decreased rate of tissue necrosis, lymphatic fluid collection, hemolytic fluid collection, and edema. Early fasciotomy of the dorsal hand and VAC apply is the alternative treatment of the snake bite.

키워드

참고문헌

  1. Jun DH, Lee DP, Choi WI: Initial assessment of the snakebites with local effects. J Kor Soc Emerg Med 15: 523, 2004
  2. Jin SC, Lee JW, Yang SJ, Joo MD, Choi WI: Consideration of factors associated with complications and systemic symptoms of snake bites. J Kor Soc Emerg Med 19: 686, 2008
  3. Lee JH, Jang SW, Kim CH, Ahn HC, Choi SS: Reconstruction of soft tissue defects after snake bite. J Korean Soc Plast Reconstr Surg 36: 605, 2009
  4. Han SK, Kim IS, Ryu S, Lee JW, Kim SW, Yoo IS, You YH, Park JS, Min MG: The effectiveness of antivenin in treating snake bites resulting in minimal clinical symptoms. J Kor Soc Emerg Med 18: 577, 2007
  5. Kim SP, Yoon DH, Kim SJ, Cho SH, Cho NS: A case report of hyponatremia resulting from treatment of anaphylaxis and rhabdomyolysis in a snake bite patient. J Kor Soc Emerg Med 18: 263, 2007
  6. Morykwas MJ, Simpson J, Punger K, Argenta A, Kremers L, Argenta J: Vacuum-assisted closure: state of basic research and physiologic foundation. Plast Reconstr Surg 117: 121S, 2006 https://doi.org/10.1097/01.prs.0000225450.12593.12
  7. Lim CY, Lee JH, Moon TI, Chu YS, Ko TI, Sohn SW, Choi SW, Kim OJ: A case of severe snake bites of the genus agkistrodon for pediatric patients. J Kor Soc Emerg Med 15: 128, 2004
  8. Dart RC, Hurlbut KM, Garcia R, Boren J: Validation of a severity score for the assessment of crotalid snakebites. Ann Emerg Med 27: 321, 1996 https://doi.org/10.1016/S0196-0644(96)70267-6