Wide local excision of the venom injection area; a possible alternative method to antivenom application in the treatment of cerastes cerastes viper envenomation in experimental animals

Background: Viper envenomation is one of the common toxicities encountered in temperate countries; and one of the important causes of death. Egypt is one of the countries suffering from this problem. Cerastes cerastes is one of the most abundant venomous viper species in North Africa and the Middle East. Envenomation by vipers is characterized by prominent local tissue damage as well as systemic alterations in the form of coagulopathy that induces spontaneous hemorrhage. Antivenoms are the mainstay of treatment; however they are of little effectiveness in treating the local effects. Owing to their side effects and the decrease in their overall worldwide production, new therapeutic strategies are encouraged worldwide. The aim of the present work was to study the efficiency of wide local excision of the venom injection site in ameliorating the effects of Cerastes cerastes viper venom in adult albino rats. Methods: Six groups of adult albino rats; each comprising 6 rats of both sexes were used in this study. Three groups were used as controls. One group was injected with venom only, and two groups were injected with venom followed by the surgical procedure. An appropriate volume of the reconstituted venom containing the LD50 was injected subcutaneously to each rat. This was followed in the two groups by excision of a calculated area of the skin and subcutaneous tissue around the injection site. The skin defect was closed by undermining and direct closure in one group and by using Limberg flap in the other group. Healing and cosmetic results were compared in both groups. Results: The study groups with wide local excision of the venom injection area showed statistically significant correction of the blood picture, coagulation profile and CPK level when compared to the results of the group with unopposed venom effects. Local healing progressed normally in the surgically treated groups with a normal scar observed after complete superficial healing and there was no incidence of infection or skin edge necrosis. Conclusions: Wide local excision of the venom injection area was proved efficient in ameliorating the systemic alterations caused by Cerastes cerastes viper venom. It also produced a cosmetically appealing scar that is not reached with using other treatment strategies owing to the occoccurrence of the healing process in healthy tissues in our case. The use of Limberg flap produced better cosmetic results than direct closure