Algorithmic approach to the prevention of unnecessary fasciotomy in extremity snake bite.
BACKGROUND
In the literature, there is a lack of a consensus about the occurrence of the compartment syndrome due to the snake bites. There are different concepts for the surgical treatment of the threshold value of the chamber pressure. There are many different classifications and assessment criteria for the snakebites.


OBJECTIVE
There is not any appropriate classification in order to the assessment of extremity snake bites while making a decision for fasciotomy. We aimed to standardize the follow-up and decision making to perform fasciotomy with a new classification system for the snakebites using objective data.


METHODS
The data of all patients were recorded prospectively between 2006 and 2011. A total of 97 patients (64 male, 33 female) with a mean age of 30.94±14.04 were followed-up. During the evaluation of the patients, we used a new classification system that was improved for the extremity bites. We classified the patients due to their signs into four groups as for the classification system.


RESULTS
40 patients with compartment like symptoms were carefully followed for 48-72h, and only three patients required fasciotomy where full recovery was achieved in 37 patients. Coverage of the defects was performed with full thickness skin grafting in 4 patients and cross finger flap in two patient. In two patients, the defects were located on the palmar aspect of the thumb. Thus, we applied Kite flap for skin coverage. Reverse dorsal digital artery flap was performed in eight patients and dorsal interosseous metacarpal flap in six patients. Four patients underwent an amputation. Two patients had web reconstruction due to first web contracture.


CONCLUSIONS
We present a large series of snake bite injuries and propose a classification and treatment recommendations. Fasciotomy should only be done while the measurement of intra-compartment pressure is above 55mmHg as snakebite can mimic the compartment syndrome.


METHODS
III-IV.
Department of Plastic and Reconstructive Surgery at Istanbul University, Cerrahpaşa School of Medicine, İstanbul, Turkey.
Arif
A
Türkmen
Department of Plastic and Reconstructive Surgery at Mustafa Kemal University, School of Medicine, Hatay, Turkey. Electronic address: drmetintemel@hotmail.com.
Metin
M
Temel
D000328:Adult; D000465:Algorithms; D000818:Animals; D003161:Compartment Syndromes / Q000209:etiology / Q000473:pathology* / Q000517:prevention & control; D020000:Decision Support Systems, Clinical; D003937:Diagnosis, Differential; D005121:Extremities / Q000473:pathology* / Q000601:surgery; D005205:Fascia / Q000473:pathology*; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012909:Snake Bites / Q000150:complications / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D014421:Turkey; D019564:Unnecessary Procedures
Adder bite; Compartment syndrome; Envenoming management; Finger defect; Revers dorsal metacarpal flap; Snake bite