Fasciotomy in compartment syndrome from snakebite

Abstract

Background: Local symptoms and signs of snake envenomation mimic the clinical features of compartment syndrome. It is important to measure the intracompartmental pressure to diagnose compartment syndrome. In this study, we present our experiences of confirming compartment syndrome and performing fasciotomy in snakebite patients based on high intracompartmental pressure findings.

Methods: The medical records of patients who visited the trauma center of Wonju Severance Christian Hospital from January 2010 to December 2015 for the management of venomous snakebite were retrospectively reviewed. Starting in 2014, fasciotomy was performed in patients with an intracompartmental pressure of more than 40 mmHg in addition to the clinical symptoms of compartment syndrome.

Results: A total of 158 patients with snakebite came to the hospital within 48 hours for treatment. Most patients (110 patients) were bitten at the upper extremities (69.6%). Since 2014, 33 out of 59 patients were suspected to have compartment syndrome, and their intracompartmental pressures were measured. Seventeen of those patients had a high intracompartmental pressure (average, 49.6 mmHg; range, 37-88 mmHg), and fasciotomy was performed.

Conclusions: In this study, as many as 10.8% of all cases were in need of fasciotomy when compartment syndrome was diagnosed by measuring the intracompartmental pressure. Previously, it was reported that fasciotomy was not required in many cases of compartment syndrome originating from snakebite. However, some patients may develop very severe compartment syndrome, requiring fasciotomy.

Keywords: Compartment syndromes; Fasciotomy; Snake bites.

Fig. 1.. Intracompartmental pressure measurement

(A) The tissue pressure is measured by a closed system with a manometer. (B) A minute quantity of saline was injected into the tissue within the closed compartment and delivered force to the manometer.

Fig. 2.. Case of fasciotomy

(A) A 65-year-old woman was bitten from snake on the right second finger. (B) After few hours later, painful swelling with paresthesia was observed on the fingers and hand. (C) Fasciotomy was performed on dorsal side of the hand, immediately postoperative image. (D) One day after the operation, symptoms were significantly decreased. (E) Two weeks after postoperatively, symptoms almost relief and wound healing by secondary intention.