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• W2022244609 abstract "To the Editor: We read with interest the article by Tanen et al1Tanen D.A. Danish D.C. Grice G.A. et al.Fasciotomy worsens the amount of myonecrosis in a porcine model of crotaline envenomation.Ann Emerg Med. 2004; 44: 99-104Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar in the August 2004 issue of Annals and are concerned that the methodological model does not provide an accurate analogy of the course of events after a crotaline snake envenomation. Compartment syndrome rarely develops in an affected limb after a deep muscular injection of venom. It is only in the setting of documented compartment syndrome that surgical decompression by means of fasciotomy is recommended. In this study, fasciotomy was performed before the development of elevated compartment pressures. This forces the reader to question whether fasciotomy would be beneficial compared with a control (with compartment syndrome) if it were performed after the development of compartment syndrome. Although the authors do state in their Limitations section that the fasciotomy itself may have worsened the observed myonecrosis, we think the greater limitation is the prevention of the possible occurrence of any benefit by performing the procedure too soon. Additionally, the results of the study showed no benefit with the therapeutic administration of antivenom, an accepted therapy for significant envenomations and increased compartment pressures.2Tanen D.A. Danish D.C. Clark R.F. Crotalidae polyvalent immune Fab antivenom limits the decrease in perfusion pressure of the anterior leg compartment in a porcine crotaline envenomation model.Ann Emerg Med. 2003; 41: 384-390Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar This finding further questions the validity of the proposed model. It is understood that external validity must be questioned with any animal study that seeks eventual application to the treatment of human disease. However, we believe that study design should follow the known course of events observed in human beings as closely as possible. For this reason, it is our opinion that the results of this study are not useful in the study of the effectiveness of fasciotomy in crotaline envenomations. Fasciotomy worsens the amount of myonecrosis in a porcine model of crotaline envenomationAnnals of Emergency MedicineVol. 44Issue 2PreviewWe evaluate the efficacy of fasciotomy or crotaline snake antivenom in reducing myonecrosis. Full-Text PDF ReplyAnnals of Emergency MedicineVol. 45Issue 3PreviewIn reply: Full-Text PDF" @default.
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• W2022244609 title "Fasciotomy After Envenomation: Measure Twice and Cut Once" @default.
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• W2022244609 doi "https://doi.org/10.1016/j.annemergmed.2004.08.049" @default.
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