Surgical implications of snakebites.
OBJECTIVE
Snakebites are a common problem in the pediatric age group. Local complications such as necrosis and compartment syndrome threaten limb survival even after control of systemic manifestations. Few recommendations exist about the nature and timing of surgical treatment.


METHODS
A retrospective review of all children with snakebites presenting to the hospital was undertaken over a 6-year period. Records were reviewed with special emphasis on the type of surgical lesions seen and the treatment offered and their results.


RESULTS
44 of the 58 children required some form of local therapy. In the majority conservative treatment was successful. 28% of the patients needed debridement for local necrosis, and only 5 needed a skin graft, with good functional results over a period of 1 to 45 days. One child underwent an above knee amputation. Patients who required surgical intervention received significantly more vials of antivenin.


CONCLUSIONS
Local complications of snakebite are frequent, but can be managed conservatively. Delayed excision of the resultant local necrosis is associated with good outcomes. The need for fasciotomy is rare.
Chattopadhyay
Anindya
A
Department of Pediatric Surgery, Kasturba Medical College, Manipal, Karnataka, India. achattopadhyay@yahoo.com
Patra
Rishab Dev
RD
Shenoy
Vijaya
V
Kumar
Vijay
V
Nagendhar
Yoga
Y
D000293:Adolescent; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000997:Antivenins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000379:methods; D012909:Snake Bites / Q000175:diagnosis* / Q000601:surgery*; D012910:Snake Venoms / Q000009:adverse effects; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
D000900:Anti-Bacterial Agents; D000997:Antivenins; D012910:Snake Venoms