• Archives of Plastic Surgery
• /
• v.38 no.1
• /
• pp.121-126
• /
• 2011

Purpose: Vaccum-assisted closure (VAC) has rapidly evolved into a widely accepted treatment of contaminated wounds, envenomations, infiltrations, and wound complications. This results in a sealed, moist environment where tissue is given the opportunity to survive as edema is removed and perfusion is increased. Many plastic surgeons now place a VAC device directly over the fasciotomy site at the time of the initial procedure. Large amounts of the fluid are withdrawn, and fasciotomies can be closed primarily sooner. This study was designed to observe the effect of VAC in preventing complications in snake bitten hands. Methods: In our study of three cases of snake bite, three of them underwent the VAC treatment & fasciotomy of the wound in the hand. This cases, the posterior compartment of the hand was bitten for a few days, releasing incisions were made of the posterior hand and 125 mmHg of continuous vacuum was applied to fasciomy incision site and the biting wound. The dressings were changed three times per week. Results: Our study examining the effects of applied vacuum in preventing snake bite wounds showed that the incidence of tissue necrosis and compartment syndrome was significantly lower for vacuum-treated wounds than for conservative wounds. Serum myoglobin, CK-MB, and CPK levels measured after fasciotomy incision were significantly decreased. We obtained satisfactory results from early dorsal fasciotomy, drainage of the edema with the VAC system, and then primary closure. The postoperative course was uneventful. Conclusion: Envenomation is a term implying that sufficient venom has been introduced into the body to cause either local signs at the site of the bite and/or systemic signs. Use of the vacuum-assisted closure device in snake bite can result in a decreased rate of tissue necrosis, lymphatic fluid collection, hemolytic fluid collection, and edema. Early fasciotomy of the dorsal hand and VAC apply is the alternative treatment of the snake bite.

• The Korean Journal of Pain
• /
• v.27 no.1
• /
• pp.68-71
• /
• 2014

The occurrence of CRPS after a snake bite was very rare, only two cases were reported worldwide. Here we report a case that the 44-year-old female patient bitten by snakes CRPS type 1 was treated consecutive intravenous regional block, lumbar sympathectomy and antiepileptic drug therapy, also discuss the possible pathophysiology.

• The Korean Journal of Nuclear Medicine
• /
• v.19 no.2
• /
• pp.105-107
• /
• 1985

It is very difficult to check the severity and clinical course of the toxicity in snake bite patients by virtes of clinical manifestation and laboratory tests. And we observed the. findings of bone scan with 99mTc-MDP in two snake bite patients. First patient was bitten in the right ankle with local pain and swelling. The finding of bone scan of him was increased uptake of radionuclide in the soft tissue of right leg and thigh. Others were normal findings. Second patient was bitten in the right hand. But his symptom was severe and he complained local pain and swelling, nausea, blurred vision, and oliguria. The bone scan findings of second patient was; Increased uptake of radionuclide in the soft tissue of whole body. Decreased uptake in the bone tissue. Renal outline was not delineated. Follow up study 10 days after, revealed more improved findings in the scan.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.15 no.1
• /
• pp.1-10
• /
• 2017

Purpose: This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings. Methods: We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared. Results: Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017). Conclusion: In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.7 no.2
• /
• pp.105-112
• /
• 2009

Purpose: There have been local wound complications in patients who have received first aid after venomous snake bites. Yet first aid in relation to local wound complications has not been well studied. Methods: We conducted a 5-year retrospective study of 111 snake bite patients who visited the emergency departments of several medical centers between January 2004 and December 2008. We categorized the patients into those who had complications with inadequate first aid, those who had complications without first aid those who had complications with adequate first aid. We compared the genera characteristics and the laboratory and clinical findings of the three groups. Results: The ale o female ratio was 1.36. The most common bite site was fingers. The most common systemic symptom was dizziness (6.3%) and the most common complication was rhabdomyolysis (23.4%). The inadequate first aids group had more local complications (cellulitis, skin necrosis) than did the group with adequate first aid or the group with no first aids. Conclusion: Inadequate first aid after snake bite leads to local complications, so we must be careful to administer first aid after snake bite and evaluate this first aid in elation to local complications.

• Journal of agricultural medicine and community health
• /
• v.45 no.3
• /
• pp.154-161
• /
• 2020

Purpose: The purpose of this study is to compare the clinical features and complications of snake bite patients in urban and rural areas. Methods: A retrospective study was conducted on patients over 18 years of age who were hospitalized for snake bites from January 2013 to December 2019. Patients were categorized into urban and rural groups according to their respective locations at the time of the snake bite and the clinical characteristics and complications of the two patient groups were researched and compared. Results: Of the 77 snake bite patients, 44 patients were categorized into the rural group (57.1%). The rura1 group showed significant differences in old age (p=0.011), delayed hospital visits (p=0.010), far hospital distance (p<0.001), high local effect score (p<0.001), high traditional snake-bite severity grading scale (p=0.008) and use of large amounts of antivenins (p=0.026). There was a significantly higher incidence of acute kidney injury (p=0.030), rhabdomyolysis (p=0.026), and coagulopathy (p=0.033) in the rural group as well as a longer hospitalization period (p<0.011). Conclusion: Snake bites that occurred in rural areas resulted in patients with more complications compared to urban areas due to farther distances from hospitals, causing a delay in antivenom treatment.

• Archives of Plastic Surgery
• /
• v.36 no.5
• /
• pp.605-610
• /
• 2009

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.

• Natural Product Sciences
• /
• v.12 no.3
• /
• pp.153-156
• /
• 2006

The antisnake venom activity of Clerodendrum viscosum Vent. (Fam. Verbenaceae), a plant traditionally used in India for the treatment of snake bite was evaluated by in vitro and in vivo methods. While in vitro studies were performed using human blood, in vivo studies were carried out using mice administered three different i.p doses of the extract, 5 min before the administration of Naja naja snake venom. The results of the in vitro studies showed that the extract probably interacts with but does not stabilize membrane protein. In the in vivo studies the extract showed significant antisnake venom activity, which may be attributed to its possible interference with the acetylcholine receptor sites. Hence the present investigation justifies the traditional use of Clerodendrum viscosum (C. viscosum) as antisnake venom.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.7 no.2
• /
• pp.90-96
• /
• 2009

Purpose: This study explored and evaluated the systemic complications resulting from the bite of Korean venomous snake, focussing on hematologic and neurologic features. Methods: Medical records (demographic data, clinical measurements including laboratory results, severity score, and amount of antidote administration, and hospitalization course) of consecutive patients who presented with snakebites to two university teaching hospital during a 10-year period were retrospectively reviewed. Subgroup analysis was conducted for evaluations of anti-acetylcholine esterase administration in complicated victims. Results: The 170 patients displayed occurrence rates of hematologic and neurologic complications of 12.9% and 20.6%, respectively. Among 22 patients with hematologic complications, isolated thrombocytopenia was evident in eight patients (36.4%), prothrombin time (PT) / activated partial thromboplastin time (aPTT) prolongation in 11 patients (50.0%), and both in three patients (13.6%). The mean time to recovery was $4.5{\pm}1.8$ days for isolated thrombocytopenia, and $5.1{\pm}1.8$ days for PT and aPTT prolongation. Hematologic complications could occur suddenly 1?4 days after hospitalization. Among 35 patients with neurologic complications, dizziness was evident in 16 patients (45.7%), and diplopia / blurred vision in 19 patients (54.3%). The mean time to recovery was $3.4{\pm}0.6$ days in patients receiving anti-acetylcholine esterase and $6.9{\pm}1.8$ days in those not receiving anti-acetylcholine esterase (p=0.00). Conclusion: Occurrence rates of hematologic and neurologic complications following venomous snake bite differed as compared to other studies conducted in Korea. Onset of hematologic complications can occur rapidly days after admittance. Anti-acetylcholine esterase administration may be effective in treating neurologic complications.

• Archives of Plastic Surgery
• /
• v.42 no.2
• /
• pp.254-256
• /
• 2015