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病例报告:蛇伤的外科处理——筋膜切开术的相关性。

Case Report: Snakebite Surgical Management-Relevance of Fasciotomy.

机构信息

Orthopaedic and Traumatologic Department, CHU Martinique (University Hospital of Martinique), Fort-de-France, France.

Physiology Department, CHU Martinique (University Hospital of Martinique), Fort-de-France, France.

出版信息

Am J Trop Med Hyg. 2018 Nov;99(5):1350-1353. doi: 10.4269/ajtmh.18-0393.

Abstract

is an endemic species in Martinique, where approximately 30 cases of envenoming are managed yearly. Envenoming characteristics from species include local tissue damage, systemic bleeding, and hemodynamic alterations. We hereby report a case of severe envenomation following snakebite to the right calf. Severe local manifestations developed progressively up to the lower limb despite adequate antivenom therapy. Systemic manifestations of venom also occurred, resulting in intensive care therapy. Surgery exploration revealed soft tissue necrosis, friability of the deep fascia, and myonecrosis. The patient needed multiple debridement procedures and fasciotomy of all leg compartments and anterior compartment of the thigh. Diagnosis of necrotizing fasciitis was confirmed by positive blood cultures. This clinical case illustrates that major soft tissue infection, including necrotizing fasciitis may occur after snakebite. Abnormal coagulation tests should not delay surgical management, as severe envenoming is a life-threatening condition.

摘要

是马提尼克岛的地方性物种,每年约有 30 例中毒病例得到治疗。 物种的中毒特征包括局部组织损伤、全身性出血和血液动力学改变。我们在此报告一例右小腿被咬伤后严重中毒的病例。尽管接受了适当的抗蛇毒血清治疗,但严重的局部表现仍逐渐发展到下肢。毒液的全身表现也发生了,导致需要重症监护治疗。手术探查显示软组织坏死、深筋膜脆弱和肌坏死。患者需要多次清创术和所有腿部隔间以及大腿前隔间的筋膜切开术。阳性 血培养证实了坏死性筋膜炎的诊断。该临床病例表明,蛇咬伤后可能会发生严重的软组织感染,包括坏死性筋膜炎。异常的凝血试验不应延迟手术治疗,因为严重的中毒是一种危及生命的情况。

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