Download PDF
CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2017; 45(01): 050-056
DOI: 10.1055/s-0037-1602749
Update Article | Artículo de Actualización
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Síndrome compartimental en extremidad superior tras mordedura de ofidio en España

Compartment Syndrome in Upper Limb after Ophidian Bite in Spain
Belén Cinta Grijelmo Sada
1   Médico Interno Residente de Cirugía Plástica, Estética y Reparadora en el Hospital Universitario de Burgos, Burgos, Spain
,
Miguel Eugenio Estefanía Díez
2   Cirujano Plástico del Hospital Universitario de Burgos, Burgos, Spain
,
David Alonso Peña
3   Cirujano Plástico del Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
,
María Elena Ruiz Alonso
2   Cirujano Plástico del Hospital Universitario de Burgos, Burgos, Spain
,
María Jesús Rivera Vegas
2   Cirujano Plástico del Hospital Universitario de Burgos, Burgos, Spain
,
María Pilar García Cano
2   Cirujano Plástico del Hospital Universitario de Burgos, Burgos, Spain
› Author Affiliations
Further Information

Publication History

23 March 2017

03 April 2017

Publication Date:
14 June 2017 (online)

   Permissions and Reprints

Resumen

La mordedura de víbora en España es un hecho infrecuente pero que puede ser grave y presentar potenciales complicaciones tales como el síndrome compartimental. Conocer su manejo es clave para evitar secuelas. La extremidad superior es la localización más frecuente de la mordedura. Sin embargo, existe controversia acerca de cuál es el tratamiento indicado, y aunque tradicionalmente se ha abogado por las fasciotomías, publicaciones más recientes apoyan el uso de antivenenos como principal tratamiento por su gran efectividad y tolerabilidad. En el presente trabajo de actualización, se realiza una puesta al día con las publicaciones más relevantes, proponiendo el manejo mediante la administración de faboterápicos (antivenenos) y la medición de la presión intracompartimental antes de realizar una fasciotomía.

Abstract

Viper envenomation in Spain is an uncommon event, but it could be severe and with complications such as a compartment syndrome. Upper extremity is the most frequent site of the bite. Knowledge of the management of this pathology is essential to avoid serious long-term sequels. However, there exist a controversy as to which is the best treatment. Although traditionally the “gold standard” treatment has been a fasciotomy, recent publications indicate/propose the use of antivenoms which are very effective and with great tolerability. An update of the topic is made with the most relevant papers with a proposal for the simple management by means of the administration of antivenom and measurement of the intracompartmental pressure before carrying out a fasciotomy.

Palabras Clave

mordeduras de serpientes - envenenamiento por serpiente - síndrome compartimental - antivenenos

Keywords

snake bite - snake envenomation - compartment síndrome - upper limb - antivenoms
 

  • Bibliografía

  • 1 Ballesteros S, Ramon MF, Martinez-Arrieta R. Epidemiology of envenomations in Spain. Clin Toxicol 2006; 44: 516-517
    PubMedGoogle Scholar
  • 2 Hall EL. Role of surgical intervention in the management of crotaline snake envenomation. Ann Emerg Med 2001; 37 (02) 175-180
    CrossrefPubMedGoogle Scholar
  • 3 Avila-Agüero ML. , et al. Venomous snakebite in children and adolescents: a 12 year retrospective review. J Venom Anim Tox 2001; 7 (01) 69-84
    PubMedGoogle Scholar
  • 4 Anz AW, Schweppe M, Halvorson J, Bushnell B, Sternberg M, Andrew Koman L. Management of venomous snakebite injury to the extremities. J Am Acad Orthop Surg 2010; 18 (12) 749-759
    CrossrefPubMedGoogle Scholar
  • 5 Bucaretchi F, de Capitani EM, Hyslop S. , et al. Compartment syndrome after Bothrops jararaca snakebite: monitoring, treatment, and outcome. Clin Toxicol (Phila) 2010; 48 (01) 57-60
    CrossrefPubMedGoogle Scholar
  • 6 Garfin SR, Castilonia RR, Mubarak SJ, Hargens AR, Russell FE, Akeson WH. Rattlesnake bites and surgical decompression: results using a laboratory model. Toxicon 1984; 22 (02) 177-182
    CrossrefPubMedGoogle Scholar
  • 7 Bush SP, Green SM, Laack TA, Hayes WK, Cardwell MD, Tanen DA. Pressure immobilization delays mortality and increases intracompartmental pressure after artificial intramuscular rattlesnake envenomation in a porcine model. Ann Emerg Med 2004; 44 (06) 599-604
    CrossrefPubMedGoogle Scholar
  • 8 Garfin SR, Castilonia RR, Mubarak SJ, Hargens AR, Akeson WH, Russell FE. The effect of antivenin on intramuscular pressure elevations induced by rattlesnake venom. Toxicon 1985; 23 (04) 677-680
    CrossrefPubMedGoogle Scholar
  • 9 Cumpston KL. Is there a role for fasciotomy in Crotalinae envenomations in North America?. Clin Toxicol (Phila) 2011; 49 (05) 351-365
    CrossrefPubMedGoogle Scholar
  • 10 Lykissas MG, Koulouvaris P, Kostas-Agnantis I, Gkiatas I, Milionis HJ, Mavrodontidis AN. Snakebites of fingers or toes by viperidae family members: an orthopaedic approach. Acta Orthop Belg 2011; 77 (02) 246-251
    PubMedGoogle Scholar
  • 11 Haddad Jr V, Sardenberg T. Management of venomous injuries. En: Green PD. (Ed). Operative Hand Surgery. 6a ed. New York: Churchill Livingstone; 2011. . p.1951
    Google Scholar
  • 12 Tanen DA, Danish DC, Grice GA, Riffenburgh RH, Clark RF. Fasciotomy worsens the amount of myonecrosis in a porcine model of crotaline envenomation. Ann Emerg Med 2004; 44 (02) 99-104
    CrossrefPubMedGoogle Scholar
  • 13 Gold BS, Barish RA, Dart RC, Silverman RP, Bochicchio GV. Resolution of compartment syndrome after rattlesnake envenomation utilizing non-invasive measures. J Emerg Med 2003; 24 (03) 285-288
    CrossrefPubMedGoogle Scholar
  • 14 Gold BS, Barish RA, Dart RC. North American snake envenomation: diagnosis, treatment, and management. Emerg Med Clin North Am 2004; 22 (02) 423-443 , ix
    CrossrefPubMedGoogle Scholar
  • 15 Estefanía ME. Síndrome compartimental tras mordedura de ofidio. En: Amate Blanco JM, Conde Espejo P. , editors. Intoxicaciones por mordeduras de ofidios venenosos (I Panel de expertos en España). IPE 2012/68. Agencia de Evaluación de Tecnologías Sanitarias (AETS). Madrid: Instituto de Salud Carlos III; 2012. . p.83–92
    Google Scholar
  • 16 Shaw BA, Hosalkar HS. Rattlesnake bites in children: antivenin treatment and surgical indications. J Bone Joint Surg Am 2002; 84-A (09) 1624-1629
    PubMedGoogle Scholar
  • 17 Russell FE. Snake venom poisoning in the United States. Annu Rev Med 1980; 31: 247-259
    CrossrefPubMedGoogle Scholar
  • 18 Stewart RM, Page CP, Schwesinger WH, McCarter R, Martinez J, Aust JB. Antivenin and fasciotomy/debridement in the treatment of the severe rattlesnake bite. Am J Surg 1989; 158 (06) 543-547
    CrossrefPubMedGoogle Scholar
  • 19 Juckett G, Hancox JG. Venomous snakebites in the United States: management review and update. Am Fam Physician 2002; 65 (07) 1367-1374
    PubMedGoogle Scholar
  • 20 Estefanía Díez M, Alonso Peña D, García Cano P, López Gamo A. Tratamiento de la mordedura por víbora en España. Semergen 2016; 42 (05) 320-326
    CrossrefPubMedGoogle Scholar
  • 21 Boels D, Hamel JF, Bretaudeau Deguigne M, Harry P. European viper envenomings: Assessment of Viperfav™ and other symptomatic treatments. Clin Toxicol (Phila) 2012; 50 (03) 189-196
    CrossrefPubMedGoogle Scholar
  • 22 de Haro L, Lang J, Bedry R. , et al. [Snake bite by European vipers. A multicenter study of tolerance to Viperfav, a new intravenous antivenom]. Ann Fr Anesth Reanim 1998; 17 (07) 681-687
    CrossrefPubMedGoogle Scholar
  • 23 Martín C, Nogué S. Novedades en el envenenamiento por mordedura de víbora. Med Clin (Barc) 2015; 144 (03) 132-136
    CrossrefPubMedGoogle Scholar