Hyperbaric oxygen therapy improves outcome of snake envenomation: tertiary center experience

Abstract

Aim: Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities. These injuries often complicated by cellulitis, gangrene, regional lymphadenopathy, compartment syndrome, bleeding abnormalities, septicemia, hypotension, and disseminated intravascular coagulation, resulting in significant morbidity and mortality. The purpose of the study is to share our experience of hyperbaric oxygen (HBO) therapy in the management of snakebite injuries.

Methods: All patients who were treated for snakebite injuries in our department between October 2012 and October 2013 were included in the study.

Results: Out of a total 395 patients, 174 patients treated with anti-snake venom with a mortality of 17 posttreatment. Forty-four out of the 174 patients was in the pediatric age group. Out of the patients referred to our department, 23 presented with cellulitis, 7 with compartment syndrome and 17 for the management of soft tissue cover over the extremities. Of the 47 patients, 30 involved the lower extremity and rest involved the upper extremity. All patients were subjected to HBO therapy as an adjunct. Six patients required flap cover: cross finger flap (n = 2), anterolateral thigh free tissue transfer (n = 1), lateral supramalleolar flap (n = 1), groin flap (n = 1), and dorsal metacarpal artery flap (n = 1). There was no need for fasciotomy among the patients who suffered impending compartment syndrome.

Conclusion: HBO therapy may reduce the incidence of fasciotomy and increase the effectiveness of plastic surgical modalities if administered early and may be used as a useful adjunct in the management of snake envenomation injury.

Keywords

Hyperbaric oxygen therapy / snake bite injury / soft tissue reconstruction / upper and lower extremity

References

[1] Al Qahtani MA,Al Anazi T,Binsalih S.Snake bite complicated by acute kidney injury secondary to necrotizing glomerulonephritis..Saudi J Kidney Dis Transpl2014;25:1259-62

[2] Halesha BR,Lokesh AJ,Venkatesh KB.A study on the clinic-epidemiological profi le and the outcome of snake bite victims in a tertiary care centre in Southern India..J Clin Diagn Res2013;7:122-6

[3] Singh V,Slathia SS.Hemothorax following snakebite..Indian Pediatr2012;49:242-3

[4] Bhalla G,Agarwal A.A study of clinical profile of snake bite at a tertiary care centre..Toxicol Int2014;21:203-8 PMCID:PMC4170564

[5] Harshavardhan L,Tejeshwari HL,Metri SS.A study on the acute kidney injury in snake bite victims in a tertiary care centre..J Clin Diagn Res2013;7:853-6

[6] Bosak AR,Graeme KA.A Case of neurotoxicity following envenomation by the Sidewinder rattlesnake, Crotalus cerastes..J Med Toxicol2014;10:229-31 PMCID:PMC4057548

[7] Gold BS,Barish RA.Bites of venomous snakes..N Engl J Med2002;347:347-56

[8] Lalloo DG.Snake antivenoms..J Toxicol2003;41:277-90

[9] Lavonas EJ,Banner W,Bernstein JN,Kerns WP2nd,Seifert SA,Curry SC,Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority..Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop..BMC Emerg Med2011;11:2 PMCID:PMC3042971

[10] Tanen D,Graeme K.Epidemiology and hospital course of rattlesnake envenomations cared for at a tertiary referral center in Central Arizona..Acad Emerg Med2001;8:177-82

[11] Tanen DA,Grice GA,Clark RF.Fasciotomy worsens the amount of myonecrosis in a porcine model of crotaline envenomation..Ann Emerg Med2004;44:99-104

[12] Schexnayder SM.Bites, stings, and other painful things..Pediatr Ann2000;29:354-8

[13] Lykissas MG,Kostas-Agnantis I,Milionis HJ.Snakebites of fingers or toes by Viperidae family members: an orthopaedic approach..Acta Orthop Belg2011;77:246-51

[14] Anz AW,Halvorson J,Sternberg M.Management of venomous snakebite injury to the extremities..J Am Acad Orthop Surg2010;18:749-59

[15] Rainer PP,Smolle-Juettner FM.Case report: hyperbaric oxygen in the treatment of puff adder (Bitis arietans) bite..Undersea Hyperb Med2010;37:395-8

[16] Bhutani S.Hyperbaric oxygen and wound healing..Indian J Plast Surg2012;45:316-24 PMCID:PMC3495382

[17] Sahni T,Jain M,Prasad R.Recent advances in hyperbaric oxygen therapy..Med Update2004;14:632-9