Prognostic Factors of Local Necrosis Due to Poisonous Snakebite-A Clinical Review in Mackay Memorial Hospital

Abstract

Purpose: To evaluate the prognostic factors of wound necrosis due to snakebite in northern Taiwan and determine the proper treatment for snakebites. Methods: The medical records of 117 venomous snakebite patients admitted to a medical center in northern Taiwan from 1989 to 2000 were retrospectively reviewed. The patients were separated into wound necrosis patients and normal wound healing patients. Clinical envenomation was graded on a 5-point scale. The relationship of wound necrosis, clinical grades, and associating factors was analyzed using the Chi-square method. Results: Most (74%) patients were attacked by the green habu (41 patients) and the Taiwan habu (44 patients), and most (84%) had minimal or no envenomation. The peak months of accidents were August and October. The prognostic factors related to wound necrosis were: species of snakes, local incision, local injection of antivenom, days of antibiotics given, grade of envenomation, and duration of hospital stay. Conclusion: Systemic infusion of early adequate antivenom is the effective method in preventing wound necrosis due to venomous snakebites. Local incision or local injection of antivenom is not recommended in the treatment program. Prolonged use of antibiotics is not necessary in patients with wound necrosis.