Our clinical experience in the treatment of snakebites

Objectives: We evaluated the results of medical and sur¬gical treatment for venomous snakebites and reviewed current principles of first aid and therapy for affected patients. Methods: Fourteen venomous snakebite victims (8 males, 6 females; mean age 22 years; range 7 to 75 years) were enrolled in the study. Six patients received medical treat¬ment alone, while eight patients required both medical and surgical treatments. Injury was in the upper and lower extremities in nine and five patients, respectively. Fasciotomy was performed in seven patients due to ensuing compartment syndrome, which was manifest with extreme swelling in the affected extremity and severe pain on passive stretching of the muscles at the site of the lesion. Fasciotomy site was primarily closed in three patients, whereas four patients required debridement and skin grafting. One patient, who developed necrosis due to an excessively tight tourniquet at the time of first aid, underwent amputation of the third finger at the level of the middle phalanx. The mean follow-up was 11.5 months (range 3 to 30 months). Results: Following fasciotomy, a long incision line remained in all the patients and a marked scar tissue due to skin grafting, which were associated with flexion contrac- ture deformities in two elbows (35 and 105 degrees). Hemopericardium detected in one patient was dealt with by medical treatment. The mean length of hospital stay was 11.3 days for medically treated patients, and 18.2 days fol¬lowing surgical treatment. No incidence of late serum dis¬ease or mortality was encountered. Conclusion: Management of snakebite victims include an appropriate first aid and treatment at the hospital; identifica¬tion of compartment syndrome through clinical means and measurements should lead to an indication for fasciotomy.