DOI QR코드

DOI QR Code

Fasciotomy in compartment syndrome from snakebite

  • Kim, Yong Hun (Department of Plastic and Reconstructive Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Choi, Jin-hee (Department of Plastic and Reconstructive Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Kim, Jiye (Department of Plastic and Reconstructive Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Chung, Yoon Kyu (Department of Plastic and Reconstructive Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
  • Received : 2018.05.25
  • Accepted : 2018.10.24
  • Published : 2019.01.15

Abstract

Background Local symptoms and signs of snake envenomation mimic the clinical features of compartment syndrome. It is important to measure the intracompartmental pressure to diagnose compartment syndrome. In this study, we present our experiences of confirming compartment syndrome and performing fasciotomy in snakebite patients based on high intracompartmental pressure findings. Methods The medical records of patients who visited the trauma center of Wonju Severance Christian Hospital from January 2010 to December 2015 for the management of venomous snakebite were retrospectively reviewed. Starting in 2014, fasciotomy was performed in patients with an intracompartmental pressure of more than 40 mmHg in addition to the clinical symptoms of compartment syndrome. Results A total of 158 patients with snakebite came to the hospital within 48 hours for treatment. Most patients (110 patients) were bitten at the upper extremities (69.6%). Since 2014, 33 out of 59 patients were suspected to have compartment syndrome, and their intracompartmental pressures were measured. Seventeen of those patients had a high intracompartmental pressure (average, 49.6 mmHg; range, 37-88 mmHg), and fasciotomy was performed. Conclusions In this study, as many as 10.8% of all cases were in need of fasciotomy when compartment syndrome was diagnosed by measuring the intracompartmental pressure. Previously, it was reported that fasciotomy was not required in many cases of compartment syndrome originating from snakebite. However, some patients may develop very severe compartment syndrome, requiring fasciotomy.

Keywords

References

  1. Warrell DA. Guidelines for the management of snake-bites [Internet]. New Delhi, World Health Organization: c2010 [cited 2018 Dec 5]. Available from http://apps.searo.who.int/PDS_DOCS/B4508.pdf.
  2. Whitesides TE, Haney TC, Morimoto K, et al. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res 1975;113:43-51. https://doi.org/10.1097/00003086-197511000-00007
  3. World Health Organization. Rabies and envenomings: a neglected public health issue. Report of a consultative meeting [Internet]. Geneva, WHO: c2007 [cited 2010 Feb 8]. Available from http://www.who.int/bloodproducts/animal_sera/Rabies.pdf.
  4. Williams D, Gutierrez JM, Harrison R, et al. The Global Snake Bite Initiative: an antidote for snake bite. Lancet 2010; 375:89-91. https://doi.org/10.1016/S0140-6736(09)61159-4
  5. Kasturiratne A, Wickremasinghe AR, de Silva N, et al. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med 2008;5:e218. https://doi.org/10.1371/journal.pmed.0050218
  6. Lim H, Kang HG, Kim KH. Antivenom for snake bite in Korea. J Korean Med Ass 2013;56:1091-103. https://doi.org/10.5124/jkma.2013.56.12.1091
  7. Laohawiriyakamol S, Sangkhathat S, Chiengkriwate P, et al. Surgery in management of snake envenomation in children. World J Pediatr 2011;7:361-4. https://doi.org/10.1007/s12519-011-0282-8
  8. Jang IS, Lee JA, Kim SY, et al. Clinical features in snake bite. J Korean Soc Emerg Med 1996;7:580-9.
  9. Jin SC, Lee JW, Yang SJ, et al. Consideration of factors associated with complications and systemic symptoms of snake bites. J Korean Soc Emerg Med 2008;19:686-96.
  10. Hsu CP, Chuang JF, Hsu YP, et al. Predictors of the development of post-snakebite compartment syndrome. Scand J Trauma Resusc Emerg Med 2015;23:97. https://doi.org/10.1186/s13049-015-0179-y
  11. Chattopadhyay A, Patra RD, Shenoy V, et al. Surgical implications of snakebites. Indian J Pediatr 2004;71:397-9. https://doi.org/10.1007/BF02725623
  12. Hall EL. Role of surgical intervention in the management of crotaline snake envenomation. Ann Emerg Med 2001;37: 175-80. https://doi.org/10.1067/mem.2001.113373
  13. Gold BS, Dart RC, Barish RA. Bites of venomous snakes. N Engl J Med 2002;347:347-56. https://doi.org/10.1056/NEJMra013477
  14. Watt CH Jr. Treatment of poisonous snakebite with emphasis on digit dermotomy. South Med J 1985;78:694-9. https://doi.org/10.1097/00007611-198506000-00020
  15. Wingert WA, Chan L. Rattlesnake bites in southern California and rationale for recommended treatment. West J Med 1988;148:37-44.
  16. Russell FE, Carlson RW, Wainschel J, et al. Snake venom poisoning in the United States. Experiences with 550 cases. JAMA 1975;233:341-4. https://doi.org/10.1001/jama.1975.03260040035020
  17. Nuchprayoon I, Pongpan C, Sripaiboonkij N. The role of prednisolone in reducing limb oedema in children bitten by green pit vipers: a randomized, controlled trial. Ann Trop Med Parasitol 2008;102:643-9. https://doi.org/10.1179/136485908X311786

Cited by

  1. Vipera snakebite in Europe: a systematic review of a neglected disease vol.34, pp.10, 2020, https://doi.org/10.1111/jdv.16722
  2. Vipers of Major clinical relevance in Europe: Taxonomy, venom composition, toxicology and clinical management of human bites vol.453, 2019, https://doi.org/10.1016/j.tox.2021.152724
  3. Snake Bite Management: A Scoping Review of the Literature vol.9, pp.4, 2021, https://doi.org/10.1097/gox.0000000000003506
  4. Coagulopathy after snake envenomation in South Korea vol.59, pp.10, 2019, https://doi.org/10.1080/15563650.2021.1884694