The management of upper extremity pit viper wounds.

In a series of 56 rattlesnake bites, there were 31 injuries involving the upper extremity and hand with a clinical complication rate of 32% that ranged from Volkmann's contracture to coagulopathies. The most frequent was tissue necrosis with functional joint stiffness and loss of sensibility. Because these patients were treated with a variety of regimens, an animal model was developed to determine the efficacy of the individual treatments. Sublethal intramuscular injections of Crotalus atrox venom were made in the extremity of New Zealand white rabbits. Tissue reaction monitored by swelling and hemorrhage was decreased significantly (P less than 0.05) with antivenin and antivenin-steroids, but no treatment modality prevented tissue necrosis. Clinical and laboratory experience indicates that one cannot rely on injectable medications to prevent tissue necrosis in pit viper envenomations and that operative treatment should be used in conjunction with other forms of therapy.