Necrotizing fasciitis is also similar to this, however, moves much quicker and is difficult to stop even with timely amputation. I cannot imagine what lead to the snake bit victim waiting so long to seek proper medical attention. She was about a month too late. The pain she must have endured would be extreme. Muscle death is very painful.

STRIKE]I have never seen this before![/STRIKE]

Sadly I have seen this in Africa two or three times.
After (weeks after) an puff adder bite.[

quote:

I cannot imagine what lead to the snake bit victim waiting so long to seek proper medical attention

Ignorance being the primary reason and the victim's believing in the witch-doctor's potions as a second.

In the early days of my prosthetic training, I saw this very injury once. This happened in southern New Mexico. Some kids were playing in an old abandoned farmhouse, they had been told to stay away from, on the family's farm. A young girl about ten years old got bit by a rattlesnake. She was afraid to tell her parents fearing she would be in trouble for playing in the old house. She kind of hid out at home, like kids sometime do for 24 hours or so. When the parents found out, the lower extremity was already starting to turn black. She must have gotten a heafty invenomation in the area of her lower calf. She ended up losing her leg about 6 inches below the knee. I fabricated prosthetic legs until she turned 21 and I lost track of her.

It can certainly happen!

I wonder if it was the Fer de Lance? A nasty snake for sure! Here's one Fer de Lance victim's leg-very similar.

My flats fishing guide in Belize was bitten by a Fer-d-lance a couple years ago and died in 24 hours
Nasty aggressive snakes-avoid at all costs

As most of the hunters should know the snakes venoum are necrotoxic or hemotoxic ,if there is a necrotoxic snake you must avoid torniquetes CAT or anything else .The same CAT can be usefull in a neurotoxic snake ,a dosis of corticoesteroid can be usefull in both until we get the proper treatment .
ANY hunter must have a QUICK CLOT BANDAGE,a CAT ,torniquet ,and a trocar or big gauge .3 thing that can save your life in many circusntances .But every body must have quick clot ,hem com or similar systems .

It will be ok, just give a few more days of healing

Bit of Detol and she'll be good as new.

quote:

Originally posted by juanpozzi:
As most of the hunters should know the snakes venoum are necrotoxic or hemotoxic ,

You have mentioned two broad classes of snake venom, yet
within them, snake toxins are somewhat more varied and complex:

-neurotoxins [presynaptic,postsynaptic,anticholinesterase]
-myotoxins (systemic skeletal muscle damage)
-Haemosatic system toxins (kills red blood cells, internal & external bleeding,thrombosis)
-Heamorrhagins (damage to capillaries & blood vessels)
-procoagulants
-nephrotoxins (primary & secondary damage to kidneys)
-Cardiotoxins (a true cardiotoxin will directly effect the heart, whereas mycotoxins effect the heart through the secondary stage)
-necrotoxins (kills tissue)

Neurotoxic venom - attacks the central nervous system, and starts to affect movement, breathing, swallowing, speech and sight.
Haematoxic venom - affects the blood by using up the clotting factors so it no longer coagulates leading to extensive blood loss into the tissues.
Cytotoxic venom - attacks the body cells or tissues, this bite is extremely painful, with much swelling and marked symptoms of shock.
Myotoxic venom - attacks the muscles, thus heart failure and the muscle proteins entering blood cause kidney failure.

[Some snakes have more than one of the above.] ...

King Cobra = cytotoxic & neurotoxic.

Mamba = neurotoxic.[it has a unique form of neurotoxin thats considered to be the fastest acting in the world]

Russell Viper = haemotoxic & neurotoxic.



Biochemical classification of venoms:

Polypeptide toxins- effects various; autonomic, neurotoxic, cardiotoxic, myotoxic
Phospholipase toxins- effects various; presynaptic neurotoxic, myolytic, procoagulant, cardiotoxic, necrotic
Enzyme toxins- effects various; interfere with haemostasis, necrotic, haemolytic

It is also important to understand that there may be considerable variability in venom composition even within a species,
let alone between closely related species, and even within an individual animal over time.

To be more detailed in the complexity of snake venom:

Ophitoxaemia (Venomous Snakebite)

Snake venom, the most complex of all poisons is a mixture of enzymatic and non-enzymatic compounds as well as other non-toxic proteins
including carbohydrates and metals. There are over 20 different enzymes including phospholipases A2, B, C, D hydrolases,
phosphatases (acid as well as alkaline), proteases, esterases, acetylcholinesterase, transaminase, hyaluronidase, phosphodiesterase,
nucleotidase and ATPase and nucleosidases (DNA & RNA) [1]. The non-enzymatic components are loosely categorized as neurotoxins
and haemorrhagens. Different species have differing proportions of most if not all of the above mixtures- this is why poisonous species
were formerly classified exclusively as neurotoxic, haemotoxic or myotoxic.
The pathophysiologic basis for morbidity and mortality is the disruption of normal cellular functions by these enzymes and toxins.
Some enzymes such as hyaluronidase disseminate venom by breaking down tissue barriers. The variation of venom composition from species to species
explains the clinical diversity of ophitoxaemia. There is also considerable variation in the relative proportions of different venom constituents
within a single species throughout its geographical distribution, at different seasons of the year and as a result of ageing.
The various venom constituents have different modes of action. Ophitoxaemia leads to increase in the capillary permeability which may cause
loss of blood and plasma volume into the extravascular space. This accumulation of fluid in the interstitial space is responsible for edema.
The decrease in the intravascular volume may be severe enough to compromise circulation and lead on to shock. Snake venom also has direct cytolytic
action causing local necrosis and secondary infection, a common cause of death in snake bite patients. The venom may also have direct neurotoxic action
leading to paralysis and respiratory arrest, cardiotoxic effect causing cardiac arrest, myotoxic and nephrotoxic effect. Ophitoxaemia also causes
alteration in the coagulation activity leading to bleeding which may be severe enough to kill the victim.

This is an incredible necrosis. Most of the time due to lack of oxygen, because vessels are obstructed by clots, anaerobic bacilli invaded the limb that "rots". This is more or les a wet gangrene. Here we observe a "dry" gangrene.
What's wrong in this article
"One doctor, who has seen the photograph, told MailOnline the girl will need her leg amputated but is still likely to die from the snake venom."
The venom is no longer active.

Kidney failure : not necessarily. The "rotting" muscles release their main component , the myoglobin that can seal the renal filter leading to a kidney failure. As vessels are blocked by clots they hardly can convey the myoglobin to the kidney.

The actual risk is imminent "rotting" of the limb and septiceamia.

Dear Trax besides being a PH im a certified general surgeon ex air force surgeon and ex army scouts md .I just wanted to explain the two common ways that the venoum attacks and a bit of aid in its treatment ,not write a medicine article on the matter .But if anyone if interested.
SOME GUIDELINES
Antivenom is the only effective antidote for snake venom. It is an
viii.
essential element of treatment of systemic envenoming but may be
insufficient on its own to save the patient’s life. Antivenom may be
expensive and in short supply.
It is recommended that antivenom should be used only in patients
a.
in whom the benefits of treatment are considered to exceed the
risks of antivenom reactions. Indications for antivenom include signs
of systemic and/or severe local envenoming.
Skin/conjunctival hypersensitivity testing does not reliably predict
b.
early or late antivenom reactions and is not recommended.
It is recommended that whenever possible antivenom should be
c.
given by slow intravenous injection or infusion.
Epinephrine (adrenaline) should always be drawn up in readiness
d.
in case of an early anaphylactic antivenom reaction.
No method of preventing antivenom reactions has been proved
e.
effective, including prophylactic epinephrine/adrenaline.
When no antivenom is available, judicious conservative treatment can
ix.
in many cases save the life of the patient.
In the case of neurotoxic envenoming with bulbar and respiratory
x.
paralysis, antivenom alone cannot be relied upon to prevent early death
from asphyxiation. Artificial ventilation is essential in such cases.
Conservative management and, in some cases, dialysis, is an effective
xi.
supportive treatment for acute kidney injury in victims of Russell’s
viper, hump-nosed viper and sea snake-bites.
Fasciotomy should not be carried out in snake-bite patients unless
xii.
or until haemostatic abnormalities have been corrected, clinical
features of an intracompartmental syndrome are present and a
high intracompartmental pressure has been confirmed by direct
measurement.

having taken care of quite a number of necrotizing fasciitis cases, this is not one of them. this appears more to be a form of devascularization, from the bite, with resultant withering and blackening of the distal extremity. the devascularization leads to drying out of the tissue, whereas necrotizing fasciitis is a very wet disease and the tissue would be sloughing off the leg in pieces. i saw a case like this once in a neonatal icu. a tube is put in thru the umbilical artery for direct access to the system. in this case the tube had been put in a little too far and affected blood flow to the left leg. the toes turned black, dried up and then fell off at the slightest jarring of the foot. this looks more like that.