Fasciotomy questions - Experts Forum at VenomousReptiles.org

Fasciotomy questions	Reply
by sloblk8 on October 7, 2008	Mail this to a friend!
I know why they say they do it but I was just curious (not in need thank god) if the procedure is ever truly necessary. From the few things I've read it doesn't seem like it ever is so if the time were to ever come should you make sure at all costs that the procedure is not performed?

RE: Fasciotomy questions	Reply
by FLherp on October 7, 2008	Mail this to a friend!
They may be needed, but intra-compartmental pressures should be measured to determine the presence of compartment syndrome and some other measures may be taken prior to performing surgery to relieve swelling (additional antivenom and elevation of the affected area). As the swelling is due to venom effects, neutralization of the venom present should be the goal. In a retrospective study, there were only a few in which intra-compartmental pressures were significant enough to merit surgery. If you can locate it a paper was published, see the follwing article: Can steel heal a compartment syndrome caused by rattlesnake venom?1, 2 . Annals of Emergency Medicine , Volume 44 , Issue 2 , Pages 105 - 107 R . Dart

RE: Fasciotomy questions	Reply
by Cro on October 7, 2008	Mail this to a friend!
Chris, here is another article that suggests that a Fasciotomy is often not needed, and can cause additional problems. Apparently, some doctors did them just as a routine thing, without measuring the compartment pressures. http://linkinghub.elsevier.com/retrieve/pii/S0196064404000575 Best Regards John Z

RE: Fasciotomy questions	Reply
by theemojohnm on October 7, 2008	Mail this to a friend!
I recently received an article from Al Corits written by Richard C. Dart, MD, PhD on why these procedures are not necessary. A few medical terms that I am not familiar with, and admittedly, I know very little on the subject of exactly what benefits these procedures produce systematically, or the complexities of compartment syndrom and local effects. This article is in the download section of my website, but here is a direct link: http://attachments.wetpaintserv.us/4vO8WQOqRvU2qPNc%2B0dz7A%3D%3D56472 Very interesting read. I believe Al has some strong opinions on why these proceedures are not needed in most cases, and he may be a good person to contact in you need resources for your bite protocol. I believ he keeps a copy of this article in there. Hope this helps... Take Care. ~John.

RE: Fasciotomy questions	Reply
by theemojohnm on October 7, 2008	Mail this to a friend!
Whoops, sorry guys. I must have missed that in Jeffs post. That is the same section I am speaking of. LOL.. Sorry.. ;) Take Care. ~John.

RE: Fasciotomy questions	Reply
by sloblk8 on October 7, 2008	Mail this to a friend!
Hey thanks for the info/article guys. That was everything I needed to know. Great to have that on hand. Thanks Chris

RE: Fasciotomy questions	Reply
by JoeCrotalid on October 8, 2008	Mail this to a friend!
Time to chime! The reason that many surgeons perform fasciotomy is their misguided belief that snakebites cause compartment syndrome. Snakebite symptoms often mimic compartment syndrome but often the intercompertmental pressures are not elevated or slightly elevated. I have actually got into arguemnets with surgeons over this issue especially when they don't perform measurements prior to the fasciotomy. The standard of care is always antivenin first. If compartment syndrome is suspected-measurement must be taken to confirm and antivenin must be given first. The new literature recommends administering mannitol which is an osmotic diuretic if pressures are elevated since most of the edema is caused by third spacing of fluids. The fluid is pulled from the extremity and filtered in the kidneys and urinated out. It should be given at the same time as antivenom. Post administration-the pressures need to be rechecked and only then if still elevated should a fasciotomy be considered. I actually had one surgeon tell me he could ID compartment syndrome just by looking at the patient because he had just spent 6 months in Iraq performing fasciotomies on american soldiers bit by Iraq species. Yeah Right! The only way to confirm an actual diagnosis of compartment syndrome is by checking pressures.

RE: Fasciotomy questions	Reply
by jared on October 9, 2008	Mail this to a friend!
WOW Man, Im gonna have to agree with ya Rob the only nerve damage I have is the long ugly fasciotomy scar on my finger. The first thing they wanted to do was REMOVE my thumb, index and ring finger because the surgeon said "they are gonna fall off anyway " AFTER i gave them Sean Bushes minute by minute protocol on agkistrodon bite! Also they wanted me to submerge my hand in ice water for a half hour, only after copious amounts of iv dilottid i signed for a "small"fasciotomy. I really shouldnt have but was kinda outta my mind with my arm and face being all swole and purple (and that was just one fang from a ft long cottonmouth, Yikes). My Gf is also under the impression the "only way to heal is cold hard steel", some surgeons are just that way, thats why they are surgeons. Jared

RE: Fasciotomy questions	Reply
by Cro on October 9, 2008	Mail this to a friend!
Surgens like to cutt on things, that is how they make their money. The ones who had problems with the medical boards probably wind up in the meat department of Kroker, cuttin up steaks, chickens, and fish ! LOL. Best Regards John Z

RE: Fasciotomy questions	Reply
by pictigaster1 on October 9, 2008	Mail this to a friend!
I have 0ver five foot of measureable fasciotomy scar, a arm thaT actually split from swelling and a bit of nerve damage you think .GET COMPARTMENT PRESSURE MEASUREMENTS.

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