Fasciotomy following North American pit viper envenomation in Texas 2004–2021

Abstract

Introduction

North American pit viper envenomation occurs over 4,000 times annually in the United States, with polyvalent Fab antivenom being the primary treatment. Fasciotomy is occasionally performed due to concerns about compartment syndrome. We utilized our direct access to Texas Poison Center Network data to create a new snakebite abstraction form and database on relevant available information between 2004 and 2021 and to identify, describe, and estimate the incidence of fasciotomy following pit viper envenomation in Texas.

Methods

We searched the Texas Poison Center Network database for cases during 2004–2021 using keywords such as fasciotomy, surgery, compartment pressure, and compartment syndrome. Descriptive statistics summarized the data.

Results

Of 16,911 reported envenomations, 0.69 percent involved fasciotomies (n = 117). Most common bite sites were digits/hands and lower extremities. Patients who underwent fasciotomy were typically male, aged 20–59, and 10 years younger than the total snakebite population. Only 6 percent of reported compartment syndrome cases had a compartment pressure measurement. Antivenom was administered in 101 (86.3 percent) cases, 92 (91.1 percent) of which received only Fab antivenom product. Patients with bites from rattlesnakes (47.9 percent) were associated with most fasciotomies

Discussion

Our findings suggest a potential increase in snakebite exposures, accompanied by a decrease in fasciotomies. Overall, copperheads constituted the majority of snakebites, but most fasciotomies were from rattlesnake envenomations (47.9 percent). In this cohort, compartment syndrome diagnosis and decisions regarding fasciotomy were primarily based on clinical evaluation/surgeon expertise without compartment pressure measurements. Despite the efficacy of antivenom, only 86.3 percent of patients in our study received antivenom.

Conclusions

Fasciotomy after North American pit viper envenomation in Texas is uncommon (0.69 percent) and has decreased over time, possibly due to increased antivenom use or surgeon comfort with nonsurgical management.

Keywords:

• Antivenom
• compartment syndrome
• copperhead
• envenomation
• fasciotomy
• pit viper
• rattlesnake
• snakebite
• surgery

Acknowledgements

We thank Dr. Stewart, Professor and Chair, Department of Surgery, University of Texas Health – San Antonio, for his contributions in refining the data collection tool and revising the manuscript.

Authors’ contributions

Shawn M. Varney, Haylea Stuteville, H. Tony Gao, Brett Roth, Sarah Watkins, Aaron A. Alindogan, and Daniel L. Dent contributed to the conception and design of this project. Shawn M. Varney, Sarah Watkins, H. Tony Gao, Brett Roth, and Haylea Stuteville acquired the data. Haylea Stuteville additionally analyzed and interpreted the data. Shawn M. Varney, Haylea Stuteville, and Joseph K. Maddry wrote the manuscript. All authors contributed to manuscript revision. All authors gave their final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data supporting this study’s findings are available from the corresponding author (SMV) upon reasonable request.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.