Nam Đặng Phương, Thuận Lê Quang, Quang Thái Duy, Nghĩa Phan Tuấn, Sơn Trần Thiết
Department of Plastic and Reconstructive Surgery, Hanoi Medical University, No.1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam.
Poison Control Center, Bach Mai Hospital, No.78 Giai Phong Street, Dong Da District, Hanoi, Vietnam.
JPRAS Open. 2025 May 23;45:159-169. doi: 10.1016/j.jpra.2025.05.011. eCollection 2025 Sep.
Vietnam is home to several cobra species, which cause significant local tissue damage due to their venom and secondary infections. The fingers are particularly concerning due to the high incidence of snake bites in this part of the upper extremity. Prognostic factors for the degree of necrosis related to bite characteristics and the reconstructive management of finger necrosis have not been widely studied.
From March 2022 to August 2024, we retrospectively studied cases of finger necrosis due to cobra bites that required surgical intervention. Data collected included the demographic information, fang mark characteristics, necrotic features, management, and postoperative results. Descriptive statistics and data analysis were performed.
The study included 78 patients (mean age, 54.2 ± 15.3 years; range, 13-92 years). Limb tourniquets were the most common first aid (61.5 %). Infection occurred in 56.4 % of cases. Necrosis severity was classified as superficial (33.3 %), deep (48.7 %), and gangrene (17.9 %). Gangrene was associated with tourniquet use, multiple fang marks, and bites at the distal phalanx or volar side ( < 0.05). Extensive necrosis spreading proximally was related to multiple bites, dorsal involvement, and proximal phalanx bites ( < 0.01). Negative Pressure Wound Therapy (NPWT) was used in 24.4 % of cases. The reconstructive option and the number of removed phalanges correlate with the severity and characteristics of the necrosis. Sixty patients (76.9 %) underwent reconstructive surgery, while the others (23.1 %) required amputation. The mean hospital stay was 18 ± 7.7 days (5-36 days).
Finger necrosis following cobra envenomation, factors such as the number and location of bite marks, as well as initial first aid methods, are closely related to the severity and characteristics of the necrosis. Debridement is essential for evaluating the extent of necrosis and the affected tissue components, serving as a crucial determinant in the decision between digit preservation and amputation.
越南有几种眼镜蛇，其毒液和继发感染会导致严重的局部组织损伤。由于上肢这一部位蛇咬伤的发生率很高，手指尤其令人担忧。与咬伤特征相关的坏死程度的预后因素以及手指坏死的重建治疗尚未得到广泛研究。
2022年3月至2024年8月，我们回顾性研究了因眼镜蛇咬伤导致手指坏死且需要手术干预的病例。收集的数据包括人口统计学信息、牙痕特征、坏死特征、治疗方法和术后结果。进行了描述性统计和数据分析。
该研究纳入78例患者（平均年龄54.2±15.3岁；范围13 - 92岁）。肢体止血带是最常见的急救方法（61.5%）。56.4%的病例发生感染。坏死严重程度分为浅表性（33.3%）、深部（48.7%）和坏疽（17.9%）。坏疽与使用止血带、多个牙痕以及末节指骨或掌侧咬伤有关（P<0.05）。向近端蔓延的广泛坏死与多处咬伤、背侧受累以及近节指骨咬伤有关（P<0.01）。24.4%的病例使用了负压伤口治疗（NPWT）。重建方案和切除指骨的数量与坏死的严重程度和特征相关。60例患者（76.9%）接受了重建手术，其余患者（23.1%）需要截肢。平均住院时间为18±7.7天（5 - 36天）。
眼镜蛇咬伤后手指坏死，咬伤痕迹的数量和位置以及初始急救方法等因素与坏死的严重程度和特征密切相关。清创对于评估坏死范围和受影响的组织成分至关重要，是决定保留手指还是截肢的关键因素。
