Snakebite on the hand
A 13-year-old boy presented to our hospital because of snakebite on his left hand that had occurred six hours before. He was hunting bush rats, and when he put put his hand in a hole, he was bitten. On arrival he presented clinical hemorrhagic syndrome with gingival bleeding and an edema extending to his back and shoulder. Laboratory tests carried out included WBCT20 (whole blood clotting test, 20 minutes) and the patient had incoagulable blood. Just after his admission, he received the first dose of antivenom (FAV-Afrique®) 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; and physical examination showed sensory and movement deficits (Figures 6 and 7). 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 (Figure 8).
The patient went back to the operating room every 2 or 3 days in order to clean the wound and remove necrosis. The local evolution was unfavorable. Necrosis extended to the whole hand (Figure 9). Finger amputations were necessary (Figures 10, 11, 12).
After eight surgeries, his condition finally improved and the clean wound allowed a skin graft (Figure 13).
Unfortunately, the patient ‘escaped’ at Day 25 of hospitalization, before we could manage the skin graft. We did not have news from him. Unfortunately, the habit of being outside, in the bush, with such a wound and no sanitary supplies is of poor prognosis.