Reconstruction of Soft Tissue Defects after Snake Bites

뱀교상 후 발생한 연부조직 결손의 재건

  • Lee, Jang Hyun (Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University) ;
  • Jang, Soo Won (Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University) ;
  • Kim, Cheol Hann (Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University) ;
  • Ahn, Hee Chang (Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University) ;
  • Choi, Matthew Seung Suk (Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University)
  • 이장현 (한양대학교 의과대학 성형외과학교실) ;
  • 장수원 (한양대학교 의과대학 성형외과학교실) ;
  • 김철한 (순천향대학교 의과대학 성형외과학교실) ;
  • 안희창 (한양대학교 의과대학 성형외과학교실) ;
  • 최승석 (한양대학교 의과대학 성형외과학교실)
  • Published : 2009.09.15

Abstract

Purpose: Substantial tissue necrosis after snake bites requiring coverage with flap surgery is extremely rare. In this article, we report 7 cases of soft tissue defects in the upper and the lower extremities caused by snake bites, which needed to be covered with flaps. Among the vast mass of publications on snake bites there has been no report that focuses on flap coverage of soft tissue defects due to snake bite sequelae. Methods: Seven cases of soft tissue defects with tendon, ligament, or bone exposure after snake bites were included. All patients were males without comorbidities, the average age was 35 years. All of them required coverage with a flap. In 6 cases, the defect was localized on the upper extremity, in one case the lesion was on the lower extremity. Local flaps were used in 6 cases, one case was covered with a free flap. The surgical procedures included one kite flap, one cross finger flap and digital nerve reconstruction with a sural nerve graft, one reverse proximal phalanx island flap, one groin flap, one adipofascial flap, one neurovascular island flap, and one anterolateral thigh free flap. The average interval from injury to flap surgery was 23.7 days. Results: All flaps survived without complication. All patients regained a good range of motion in the affected extremity. Donor site morbidities were not observed. The case with digital nerve reconstruction recovered a static two point discrimination of 7 mm. The patient with foot reconstruction can wear normal shoes without a debulking procedure. Conclusion: The majority of soft tissue affection after snake bites can be treated conservatively. Some severe cases, however, may require the coverage with flap surgery after radical debridement, especially, if there is exposure of tendon, bone or neurovascular structures. There is no doubt that definite coverage should be performed as soon as possible. But we also want to point out that this principle must not lead to a premature coverage. If the surgeon is not certain that the wound is free of necrotic tissue or remnants of venom, it is better to take enough time to get a proper wound before flap surgery in order to obtain a good functional and cosmetic result.

Keywords

References

  1. Warrell DA, Fenner PJ: Venomous bites and stings. Br Med Bull 49: 423, 1993 https://doi.org/10.1093/oxfordjournals.bmb.a072619
  2. Parrish HM: Incidence of treated snakebites in the United States. Public Health Rep 81: 269, 1966 https://doi.org/10.2307/4592691
  3. Shim JH: 꿈꾸는 푸른 생명, 거북과 뱀. Seoul, 다른세상, 2001, p147
  4. Baik NK, Shim JH: 뱀, 다리없는 동물, 그 진화의 수수께끼. Seoul, 지성사, 1993, p115
  5. Cho NS, Park J: A clinical analysis of snake bite injury. J Kerean Emerg Med 7: 405, 1996
  6. Kim ES, Chwoi WJ: Clinical review of venomous snake bite. J Korean Surg Soc 59: 433, 2000
  7. Dart RC, Seifert SA, Carroll L, Clark RF, Hall E, Boyer-Hassen LV, Curry SC, Kitchens CS, Garcia RA: Affinity-purified, mixed monospecific crotalid antivenom ovine Fab for the treatment of crotalid venom poisoning. Ann Emerg Med 30: 33, 1997 https://doi.org/10.1016/S0196-0644(97)70107-0
  8. Clark RF, Selden BS, Furbee B: The incidence of wound infection following crotalid evenomation. J Emerg Med 11: 583, 1993 https://doi.org/10.1016/0736-4679(93)90313-V
  9. Tenery JH, Koefoot RR: Snake bite: a case with observation on early and late treatment. Plast Reconstr Surg 15: 483, 1955 https://doi.org/10.1097/00006534-195506000-00004
  10. Bennett JE, Brelsford HG, Lewis SR, Blocker TG Jr: Distal extremity necrosis after snake bite. Plast Reconstr Surg Transplant Bull 28: 385, 1961 https://doi.org/10.1097/00006534-196110000-00005