What is it about?
We have highlighted the use of surgical fasciotomies to treat 'complications' of snakebite in Australia. Although only a few recent cases were reported in this review, fasciotomies have continued to be considered an option in subsequent specific clinical investigations since publication but not performed. It is our belief that the current trend towards this surgery is a direct result of doctors arriving from overseas where in their countries of origin they may not have observed the shallow subdermal bite site oedema commonly seen in patients here envenomed by many of our small-fanged Austropapuan elapid snakes.
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Why is it important?
Unnecessary and debilitating fasciotomies are finding their way into our hospitals as a treatment in the management of snakebite in Australia. Until recently, this surgery was unheard of here for this purpose and although still uncommon, we do not want it becoming established in our hospitals, while at the same time, there are moves overseas for it to be removed as a treatment altogether. There is no upside in the use of this surgery and a considerable downside with both the greatly extended morbidity in patients and the large additional cost in their post-operative management, especially when performed due to the illusion of compartment syndrome caused by subcutaneous swelling without objective tests determining an actual and significant increase in compartment pressure. It is our intent that by increasing awareness of unnecessary fasciotomies in snakebite treatment through this review, we may reverse the trend while still in its infancy and prevent this surgery from becoming further established here in Australia.
Perspectives
As corresponding author, I have been involved in the handling and management of Australian snakes since the mid 1950s and in that time, taken numerous bites from venomous species. Since 1987, I professionally consulted, lectured and trained personnel on venomous snake management, including emergency snakebites and their field treatment, along with catch and relocation. Extensive localised swelling and pain has always been a symptom of envenomation by members of many Australian snake genera, however, until a 2019 case we report on here and my co-author's hand and forearm fasciotomies performed in 2021, I had not heard of this type of surgery previously being associated with the treatment of Australian snakebites. Both my co-author and I sure hope it does not become fashionable in Australia.
Mr Brian Gordon Bush
Read the Original
This page is a summary of: Controversial Australian Snakebite Treatment: The Deepest Cut of All, Venoms and Toxins, October 2023, Bentham Science Publishers,
DOI: 10.2174/2666121703666230809145505.
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