Surgery should not be used as first-line treatment

Chippaux, Jean‐Philippe

doi:10.1590/s1678-91992010000100002

Cited by 5 publications

(6 citation statements)

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“…(7) Surgical intervention is not the first line management of tissue necrosis in snake envenomation. (8) Though intracompartmental pressure was advocated to assess the need for surgical intervention it is rarely ever used in developing countries. Pulseless with tense, swollen, cold limbs might suggest intracompartmental syndrome.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Management of Snake Envenomation in Children

Varadharajan¹,

Sankaran²,

Giridharan³

et al. 2017

jemds

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BACKGROUND The aim is to study the need for surgical intervention among children with snake envenomation. MATERIALS AND METHODS This was a prospective observational study from a paediatric intensive care unit of a tertiary care institute. Clinical presentation, type of envenomation, need for ASV, duration of hospital stay, surgical intervention and final outcome were studied. Data was analysed using Epi Info software. This study was undertaken after ethical approval and informed consent of caregivers. RESULTS In this study of 35 children, male female ratio was 3.4:1. 71% were neurotoxic and 69% had local envenomation. Compartment syndrome was encountered in 13 children (37.14%). Amputation of the middle finger was undertaken in one child. Initial fasciotomy with subsequent wound debridement was done in 8 children. Split skin grafting was done in 5 children. 36% of children with neurotoxic envenomation and 54% with local envenomation and 16% with haemotoxic envenomation required surgical intervention. Comparison of factors like age, gender, bite to ASV receipt time, number of ASV vials used, initial blood glucose, white blood counts, native treatment did not show any statistically significant difference as risk factors for surgical intervention. Children needing surgical intervention needed a longer hospital stay compared to those who did not need surgical intervention. Except for one child with features of Russell's viper bite others were due to cobra bite in this study group. Overall mortality was 5.7%. CONCLUSION 36% of children with snake envenomation from rural areas needed surgical intervention.

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Section: Discussionmentioning

confidence: 99%

“…(10) Role of early fasciotomy is not well documented in literature. (4,8,11) However, early fasciotomy help in enormous pain reduction in the absence of coagulopathy. Children may need multiple surgical debridement procedures in snake envenomation.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Snake Envenomation in Children

Varadharajan¹,

Sankaran²,

Giridharan³

et al. 2017

jemds

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“…This strategy was justifiable when antivenoms lacked safety and were less effective, as well as resuscitation and surgery, than nowadays. The effectiveness of fasciotomy is not yet well demonstrated and more conservative treatments are now available (4,10,11,13). On one hand, there is evidence that modern antivenoms both limit the spread of necrosis by inhibiting protease activity and reduce edema, leading to decreased risk of compartment syndrome (14,15).…”

Section: Discussionmentioning

confidence: 99%

Snakebite on the hand: lessons from two clinical cases illustrating difficulties of surgical indication

Gras¹,

Plantefève²,

Baud³

et al. 2012

J. Venom. Anim. Toxins incl. Trop. Dis

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Snakebite is a particularly important health problem in rural areas of tropical regions. A large number of victims survive with permanent physical sequelae due to local tissue necrosis. However, necrosis may be associated with compartment syndrome especially when the bite is on the hands or feet. Herein, we describe two cases reported at a rural district hospital in Central African Republic. The present study suggests that active multidisciplinary management may improve patient prognosis while evidencing how difficult it is to decide on surgical intervention.

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“…Compartment syndrome, provided that the diagnosis is confirmed by measuring intracompartmental pressures, should be treated by a fasciotomy. However, the high risks of complications (bleeding and secondary infections in particular) and significant sequelae (unsightly scars and functional impairments) must be considered, and surgical treatment should be used only after careful consideration [69] and only once any coagulopathy is reversed.…”

Section: Specific Treatment: Antivenom Immunotherapymentioning

confidence: 99%