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. 2008 Dec;3(4):324-31.
doi: 10.1007/s11552-008-9114-2. Epub 2008 May 28.

The management of pit viper envenomation of the hand

Mehmet Bozkurt  1 , Yalcin Kulahci, Fatih Zor, Emin Kapi
Affiliations

The management of pit viper envenomation of the hand

Mehmet Bozkurt et al. Hand (N Y). 2008 Dec.

Abstract

Snakebites are common among the rural population of developing countries. The severity of venomous snakebites depends on several factors, including the location of the bite, the amount of venom injected, and the effectiveness of the initial therapy. Snakebites frequently occur in the extremities with approximately two thirds of envenomations occurring in the upper extremities. In this study, we presented 12 cases of hand reconstruction after Vipera snakebites and discussed how to minimize functional loss and maximize hand rehabilitation. Twelve patients bitten by Vipera between 2001 and 2006 were included in this study. Groin flaps were performed in three cases, full-thickness grafts in two cases, thenar flaps in three cases, and cross finger flaps in three cases. With medical management, spontaneous healing occurred in one case. We prefer to use flaps on the volar site of the hand and, if the bone is not exposed, full-thickness grafts on the dorsal site of the hand. We also recommend starting rehabilitation of the hand early.

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Figures

Figure 1
Figure 1
Picture of V. lebetina.
Figure 2
Figure 2
Algorithm for the management of pit viper envenomation. LWC local wound care including immobilization of the extremity and gravity-neutral position until the neutralization of the venom.
Figure 3
Figure 3
a Appearance of skin necrosis at the right hand ring finger dorsal surface (case no. 11). b Appearance of the wound after serial debridements. c Early postoperative view. Full-thickness skin graft was applied to the defect. d Late postoperative view at 7 months after grafting. e–f Excellent functional and cosmetic results of the patient.
Figure 4
Figure 4
a Appearance of skin necrosis at the left hand ring finger distal phalanx volar site (case no. 5). b After serial debridements, the defect was seen in the distal phalanx. c Late postoperative view at 5 months after reconstruction with cross finger flap. d–e Active extension and flexion of the left hand ring finger after reconstruction.
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