Cawrse N H, Inglefield C J, Hayes C, Palmer J H
Department of Plastic Surgery, Royal Devon and Exeter Hospital, Exeter, UK.
Br J Plast Surg. 2002 Jul;55(5):434-5. doi: 10.1054/bjps.2002.3888.
Snakebite envenomation is an uncommon condition in the UK, but requires vigilance with regard to both the systemic effects of the venom and the locoregional impact on the soft tissues. We describe a case requiring delayed fasciotomies for closed compartment syndrome of the leg and thigh, and discuss in detail the controversies surrounding decompression in such a case. Adder bites are uncommon in the UK, but can result in envenomation of varying severity. Apart from the numerous possible systemic effects that require attention, there are local effects that, very rarely, can be limb threatening. Of these, elevated limb compartment pressures are of paramount importance, and recognition of closed compartment ischaemia is vital if the limb is to be saved by surgical decompression. Guidelines on threshold compartment pressures and fasciotomies are indistinct regarding snakebite, with diagnostic emphasis still placed on clinical signs and symptoms. In the paediatric setting, measurement of compartment pressures is a valuable adjunct to clinical suspicion in the diagnosis of acute compartment syndrome secondary to snakebite.
蛇咬伤中毒在英国是一种不常见的病症，但对于毒液的全身影响以及对软组织的局部影响都需要保持警惕。我们描述了一例因小腿和大腿闭合性骨筋膜室综合征而需要延迟进行筋膜切开术的病例，并详细讨论了在此类病例中围绕减压的争议。蝰蛇咬伤在英国并不常见，但可导致不同严重程度的中毒。除了众多需要关注的可能的全身影响外，还有局部影响，极少数情况下可能会威胁肢体。其中，肢体骨筋膜室压力升高至关重要，如果要通过手术减压挽救肢体，识别闭合性骨筋膜室缺血至关重要。关于蛇咬伤，骨筋膜室压力阈值和筋膜切开术的指南并不明确，诊断重点仍放在临床体征和症状上。在儿科环境中，骨筋膜室压力测量对于蛇咬伤继发急性骨筋膜室综合征的临床怀疑诊断是一项有价值的辅助手段。
