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Surgery in management of snake envenomation in children
Suppawat Laohawiriyakamol1, Surasak Sangkhathat, Piyawan Chiengkriwate
1Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Insights
Surgery is crucial for treating pediatric venomous snakebites, particularly cobra bites with tissue necrosis. This study highlights surgical interventions like debridement and skin grafting for better patient outcomes.
Area of Science:
- Pediatric Medicine
- Toxicology
- Surgical Management
Background:
- Snakebite is a significant health issue in children, especially in developing nations.
- Venomous snakebites require effective treatment strategies to minimize morbidity and mortality.
Purpose of the Study:
- To evaluate the role and effectiveness of surgical interventions in managing venomous snakebites among pediatric patients.
- To identify specific snake species and clinical presentations that necessitate surgical treatment.
Main Methods:
- A retrospective analysis of clinical data from 58 pediatric patients (aged 0-16 years) treated for venomous snakebites between 1999 and 2008.
- Review of patient demographics, snake species, bite location, clinical manifestations, and surgical procedures performed.
Main Results:
- The majority of patients were male, with peak incidence in toddlers (2-3 years). Bites commonly occurred during summer/rainy seasons and at night, primarily on lower extremities.
- Cobra bites (Naja spp.) were associated with higher rates of soft tissue necrosis (47.6%) compared to viper bites (3.6%).
- Surgical intervention was required in 13 patients, involving wound debridement and skin grafting; one patient needed toe amputation. Average hospital stay for surgical patients was 18.8 days.
Conclusions:
- Surgery plays a vital role in managing severe pediatric snakebite cases, particularly those with significant tissue necrosis.
- Prompt surgical debridement and reconstruction are essential for optimizing recovery and preventing complications in venomous snakebite victims.
Background:
Snakebite is common in children especially in the developing countries. This study was undertaken to determine the role of surgery in the treatment of venomous snake bite in pediatric patients.
Methods:
The clinical data of 58 pediatric patients aged 0-16 years who had been treated for venomous snakebite from January 1999 to December 2008 were analyzed.
Results:
Of the 58 patients, 43 (74.6%) were male. Peak age incidence was around 2-3 years (28.8%). The majority of envenomations occurred in the summer and rainy seasons, especially in the latter, during flooding. The bites occurred during 6 pm to 12 pm in 27 patients (49.0%). The main bite site was the lower extremities in 49 patients (83.9%). The main species of the snake were Malayan pit viper (Calloselasma rhodostoma) in 28 patients (47.5%) and cobra (Ophiophagus hunnah or Naja spp.) in 21 patients (35.6%). Soft tissue necrosis occurred more in cobra bites (47.6%) than viper bites (3.6%). The most common organism identified in necrotic tissue was Morganella morgagnii. Four patients with cobra bite had respiratory failure that required ventilatory support. Compartment syndrome was suspected in 2 patients. Surgical intervention was necessary in 13 patients. Most procedures involved serial wound debridement, followed by skin grafting. One case needed a toe amputation because of necrosis. The average length of hospital stay in patients who needed surgical management was 18.8 days (range: 12.1-25.5 days). There were no mortalities.
Conclusions:
Surgery plays an important role in the management of snakebite patients, especially for those with cobra bite with tissue necrosis.
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