Upper extremity compartment syndromes following pit viper envenomation

The treatment of pit viper envenomation by fasciotomy continues to be controversial because elevated intracompartment pressures have never been previously documented. Two patients with severe pit viper envenomation of the thumb had signs and symptoms of elevated intracompartment pressures. Elevated intracompartment tissue pressures were documented in both cases. Immediate fasciotomies were necessary to decompress the thenar and forearm compartments and, in one case, the upper arm as well. Ischemic tissues were noted at the time of the operation and confirmed the clinical and objective tissue pressure measurements of compartment syndromes. Both patients made complete functional recoveries following delayed primary closure. Intracompartment pressure monitoring should be routinely used in the management of pit viper envenomation to avoid disastrous sequellae.