Upper limb compartment syndrome requiring fasciotomies following a <i>Vipera ammodytes</i> (horned viper) snakebite: a case report

The clinical severity of snakebite envenomation depends on several factors, including the snake species, the amount of venom injected, the site of envenomation, the timing of antivenom administration, and patient-specific factors. Compartment syndrome is a rare but serious complication of severe envenomation, caused by toxin-induced tissue damage and swelling. We present a case of a 71-year-old man with extensive swelling and ecchymosis of the right upper limb, signs of hand ischemia, and systemic effects, including hypotension, anuria, bradycardia, bradypnea, and somnolence, two days after a Vipera ammodytes (horned viper) bite to his right forearm. Delayed initial treatment and antivenom administration (six hours post-bite due to the heavy influence of alcohol) aggravated the clinical course. Emergency fasciotomies were performed to decompress all compartments of the upper limb. Wound closure was achieved with progressive tension closure, split-thickness skin graft, and platelet-rich plasma (PRP) to the volar side of the forearm. The patient achieved complete recovery with full functional restoration of the upper limb. Post-snakebite compartment syndrome (PSCS) results from a multifactorial cascade of venom-induced local tissue injury, leading to increased intracompartmental pressure and microvascular ischemia. Prompt surgical treatment is necessary if symptoms persist or worsen despite antivenom administration.