The clinical significance and management of finger necrosis due to cobra bite in Vietnam.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.