Immediate radical fang mark ablation may allow treatment of japanese viper bite without antivenom

Abstract

Administration of antivenom is currently the standard treatment for snake envenomation. However, it can sometimes cause anaphylactic reactions including urticaria, bronchospasm and hypotension. Furthermore, it may also provoke life-threatening complications, even though the mortality rate is less than 1%. In this study, we present a new treatment -immediate radical fang mark ablation -that was successfully performed on five victims of Japanese viper bites without antivenom use. In these five victims of venomous snakebites, surgical debridement was immediately performed. Two patients received a free-skin graft to resurface their wounds while three of them healed conservatively (i.e. by ointment treatment without surgery). After treatment, all patients could return to work. Immediate radical ablation is a recommended procedure that can reduce the amount of venom in tissues, which consequently decreases inflammatory reactions and reduces the necessity for antivenom.

Although surgery should not be used as first-line treatment, immediate ablation should be performed when necrotic change around the fang mark is recognized

“…Secondly, I do not dismiss antivenom usage, as stated in our article: "Continuous observation is indispensable after ablation, and if severe systemic symptoms of envenomation occur […] antivenom treatment should be indicated with no hesitation" (2). I think this principle is the same when a patient does not undergo ablation.…”

“…Herein, I give my response and present my considerations on why immediate radical fang-mark ablation may be effective in some cases (2).…”