Risk Factors of Surgical Intervention in the Management of Venomous Snakebite in Northern Taiwan

Abstract

Venomous snakebites are not uncommon in Taiwan, and the snake venom causes both systemic and local effects. Petechiae, edema, swelling, ecchymosis, necrosis of the skin and subcutaneous tissue, and necrotizing fasciitis could be seen locally, and surgical intervention may be needed to deal with these problems. However, functional impairment and limb loss were still sometimes inevitable. We retrospectively reviewed medical records of 118 patients bitten by venomous snakes from Jan. 1999 to Dec. 2004, and risk factors of surgical intervention were studied. The relationship of the need of surgical intervention and snake species, clinical grading, symptoms, and other associating factors were analyzed. Surgery was needed in 16 of 118 patients(13.5%)bitten by venomous snakes, 7 by Taiwan cobra, 5 by Taiwan habu, 1 by green habu, 1 by hundred pacer, and 2 by unknown snake. Risk factors of surgical intervention were Taiwan cobra snakebite(7/14)and delayed given of antivenom. Taiwan cobra snakebite was found with higher risk of local necrosis and infection. Therefore, more surgical interventions were needed in this group of patients, and early antivenom given and broad spectrum antibiotics coverage were recommended