Effectiveness of early fasciotomy in the management of snakebites

BACKGROUND
The purpose of this study was to emphasize that early fasciotomy performed in the treatment of snakebites in the absence of the classic compartment syndrome criteria accelerates the clinical recovery and reduces the progressive tissue damage.
METHODS
Fourteen patients with snakebite were examined retrospectively. Five of them healed with routine treatments. Six patients who did not respond to the treatment underwent early fasciotomy procedure in 48 hours. All of the patients had edema, pain, ecchymosis, bulla formation, and progressive skin necrosis over the extremity. Fasciotomy was performed in three patients who were referred in the late period with compartment syndrome. Fasciotomy incisions were closed after 4-6 days.
RESULTS
After the early fasciotomy, edema diminished rapidly, the skin became more viable and local necrosis did not progress. Further, the toxic symptoms like local temperature increase and fever also diminished. The healing process in the three patients who underwent late fasciotomy was much slower compared with the early fasciotomy group. In particular, necrosis on the muscle and skin had deteriorated.
CONCLUSION
Fasciotomy has a special place in snakebites. In cases of compartment syndrome, all necessary treatments including early fasciotomy should be performed before the full clinical symptoms develop or the compartment pressure reaches the threshold value.

Erken fasyotominin yýlan ýsýrýklarý tedavisindeki etkinliði

AMAÇ
Bu çalýþmamýzda amacýmýz, yýlan sokmalarýna baðlý geliþen kompartman sendromlarýnýn tedavisinde, klasik kompartman sendromu kriterlerinden uzaklaþarak yapýlan erken fasyotominin hem klinik iyileþmeyi hýzlandýrdýðý hem de ilerleyici doku hasarýný azalttýðýný vurgulamaktýr.
GEREÇ VE YÖNTEM
Yýlan ýsýrmasý nedeniyle baþvuran 14 hasta geriye dönük olarak incelendi. Hastalarýn 5’i rutin tedavi ile takip edilerek iyileþtirildi. Tedaviye yanýt vermeyen 6 hastaya ekstremitede artan ödem, aðrý, peteþi-ekimoz, bül formasyonu, ilerleyici deri nekrozu ve gerilemeyen klinik ve laboratuvar bozukluklar nedeniyle ilk 48 saat içerisinde erken fasyotomi yapýldý. Geç dönemde kompartman tanýsý ile kliniðimize sevk edilen 3 hastaya ise baþvurduklarýnda fasyotomi yapýldý. Fasyotomi insizyonlarý 4 ila 6 gün sonra kapatýldý.
BULGULAR
Erken fasyotomi uygulanan 6 hastada ödemin hýzla azaldýðý, ekstremite derisindeki lokal nekrozlarýn ilerlemediði gözlendi. Ayrýca bu hastalarda lokal ýsý artýþý veya ateþ gibi toksik belirtiler hýzla geriledi. Geç fasyotomi yapýlan 3 hastada ise iyileþme hýzý erken cerrahi yapýlanlarla kýyaslandýðýnda oldukça yavaþtý ve kas ve derideki nekrotik ilerleme kýsmen geriledi.
SONUÇ
Fasyotomi yýlan ýsýrýklarýnda özel bir yere sahip olup kompartman sendromu olgularýnda gerekli tüm tedaviler uygulanmalý kliniðin tam olarak oturmasýný veya kompartman basýncýnýn eþik deðere ulaþmasýný beklemeden erken fasyotomi yapýlmalýdýr.