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 toxicity accidents encountered in temperate countries, and one of the important causes of death. Egypt is one of the countries suffering 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 haemorrhage. 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. Methods: The present work studied the efficiency of wide local excision of the venom injection site in albino rats in ameliorating the local and systemic effects of Cerastes cerastes viper venom. The study compared the healing and cosmetic results with the use of undermining and direct closure of the skin defect and the use of Limberg flap. Results: Analysis of the results revealed that wide local excision of the venom injection area was efficient in correction of all the laboratory findings caused by the venom. Local healing progressed normally with a normal scar observed after complete superficial healing and there was no incidence of infection or skin edge necrosis in the study groups. 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 occurrence of the healing process in healthy tissues in our case. The use of Limberg flap produced better cosmetic results than direct closure.