The Management of Pit Viper Envenomation of the Hand

Abstract

Snakebites are common among the rural population of developing countries. The severity of venomous snakebites depends on several factors, including the location of the bite, the amount of venom injected, and the effectiveness of the initial therapy. Snakebites frequently occur in the extremities with approximately two thirds of envenomations occurring in the upper extremities. In this study, we presented 12 cases of hand reconstruction after Vipera snakebites and discussed how to minimize functional loss and maximize hand rehabilitation. Twelve patients bitten by Vipera between 2001 and 2006 were included in this study. Groin flaps were performed in three cases, full-thickness grafts in two cases, thenar flaps in three cases, and cross finger flaps in three cases. With medical management, spontaneous healing occurred in one case. We prefer to use flaps on the volar site of the hand and, if the bone is not exposed, full-thickness grafts on the dorsal site of the hand. We also recommend starting rehabilitation of the hand early.

Snakebites in Turkey: epidemiological and clinical aspects between the years 1995 and 2004

“…Usually, local symptoms of snakebites comprise swelling (generally within two hours), pain, soreness of regional lymph nodes, bruises and necrosis on the bite site, as well as occasionally development of compartment syndrome (9,10,20). In the current work, the manifestations of snake envenomations included local symptoms such as edema, local pain, hyperemia, numbness and compartment syndrome.…”

“…The severity of venomous snakebites depends on several factors, including the bite site, the amount of injected venom, and the effectiveness of the initial therapy (20). For instance, Vipera venom possesses a variety of biological activities, and once it is injected into an animal, it may reach the bloodstream within a minute, so that its components must achieve their effects at very low concentrations (20,21).…”

“…For instance, Vipera venom possesses a variety of biological activities, and once it is injected into an animal, it may reach the bloodstream within a minute, so that its components must achieve their effects at very low concentrations (20,21).…”

“…In addition, their toxins can produce edema, vasoconstriction, and tissue necrosis due to both direct cellular destruction and vascular injury around the bite site (8,20,21).…”

“…In Turkey, systemic symptoms of snake envenomations previously reported consisted of: epistaxis; hematemesis; ecchymosis; hemoptysis; subconjunctival, retroperitoneal and intracranial hemorrhages; ptosis; weakness; paresthesia; dysphagia; sweating; respiratory depression; paralysis; myotoxicity related symptoms; disseminated intravascular coagulation; and acute renal failure (8,10,13,18,(20)(21)(22)(23)(24)(25)(26) (Figure 4).…”