Hand necrosis after a snake bite!
This 13-year-old boy presented to the hospital because of a snakebite on his left hand that had occurred six hours before. He was hunting bush rats, and when he put his hand in a hole, he was bitten. On arrival he showed clinical hemorrhagic syndrome with gingival bleeding and an edema extending to his back and shoulder. Just after his admission, he received the first dose of antivenom in association with the usual non-specific treatment (tetanus toxoid, tetanus vaccination, amoxicillin, acetaminophen, and ibuprofen). Due to persistent swelling (the edema reached the thorax) he received a second dose of antivenom six hours after the first. Then, the edema stopped increasing and there was no more clinical bleeding. Although the edema stopped growing, the hand still had a worrying aspect. The skin was very hard, nails were white, without any evidence of blood circulation. A physical examination showed sensory and movement deficits. The patient underwent surgery on Day 1. Perioperative observations showed hand compartment syndrome and deep hematomas. Fasciotomy was performed and muscles below were black with almost no blood flow.
The patient went back to the operating room every 2 or 3 days in order to clean the wound and remove necrosis. Unfortunately it extended to the whole hand. Finger amputations were necessary. After eight surgeries, his condition finally improved and the clean wound allowed a skin graft.
Unfortunately, the patient 'escaped' at Day 25 of hospitalization, before the doctors could perform the skin graft. To be outside with such a wound and no sanitary supplies makes a good prognosis nearly impossible.
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