Skin necrosis due to snakebites

Abstract

More than five million people are bitten by venomous snakes every year, resulting in 125,000 deaths, mostly in developing countries. Many reports are focused on snakebite–related mortality. However, most patients survive, and victims suffer from local complications. Snake venom contains several enzymes, nonenzymatic proteins, and peptides, which cause local edema, blisters, and skin necrosis. Antivenom is the only effective treatment to prevent death in severe cases. However, antivenin may cause an anaphylactoid reaction in 3–54 % of patients and serum sickness–type reactions in 10–75 %. Surgery also plays an important role in the management of snakebite patients with tissue necrosis. Snakebite patients with skin necrosis require serial wound debridement, followed by reconstructive surgery using skin grafting and/or a flap. Some of them undergo amputations of fingers and toes. To prevent later sequelae, snakebites are best treated acutely by surgical debridement to remove as much venom as possible. Recommended therapy for viper envenomation is the administration of antivenom. However, it carries a risk of anaphylactic reaction, and so antivenom usage should be approached with extreme caution. I successfully treated viper envenomation by performing immediate radical fang mark ablation. Immediate radical ablation is a useful procedure that can reduce the amount of venom in tissue, which, consequently, decreases inflammatory reactions and reduces the necessity of antivenom usage.