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Limb salvage following snakebite using acute limb shortening and secondary lengthening.

ABSTRACT: A case of 16-year-old boy from the remote tribal population of Uttarakhand is described, who sustained a viper snakebite. The patient after various interventions and referrals developed locoregional and systemic complications. He not only had an open tibiofibular fracture but a large bimalleolar defect over his lower limb. The wound infection with underlying osteomyelitis progressed to septic shock and failure of the conventional cross-leg flap. Computed tomography scan of the limb revealed a single patent vessel, eliminating the option of microvascular flap. Limb amputation was considered for source control; however, in an attempt to salvage the limb, the novel approach of acute limb shortening with secondary limb lengthening was performed with parental consent, an approach not previously reported in the management of snakebite injuries. Adequate infection control was achieved following removal of the osteomyelitic bone, and the defect was covered with overlapping tissue from the docked limb and a cross-thigh flap. Secondary lengthening was performed after 3 months, and following extensive surgical and rehabilitative interventions, the boy's limb was salvaged and he retains a near-normal gait. This case report entails a detailed account of how mutilating a snakebite injury could be and how unconventional techniques like acute limb shortening with secondary lengthening can be used in such injuries.

SUBMITTER: Mahakalkar SS

PROVIDER: S-EPMC8318165 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:There is a limited understanding of the neurological adaptations responsible for changes in strength following shortening and lengthening resistance training and subsequent detraining. The aim of the study was to investigate differences in corticospinal and spinal responses to resistance training of the tibialis anterior muscle between shortening or lengthening muscle contractions for 4 weeks and after 2 weeks of detraining. Thirty-one untrained individuals were assigned to either shortening or lengthening isokinetic resistance training (4 weeks, 3 days/weeks) or a non-training control group. Transcranial magnetic stimulation and peripheral nerve stimulation (PNS) were used to assess corticospinal and spinal changes, respectively, at pre-, mid-, post-resistance training and post detraining. Greater increases changes (P < 0.01) in MVC were found from the respective muscle contraction training. Motor evoked potentials (expressed relative to background EMG) significantly increased in lengthening resistance training group under contraction intensities ranging from 25 to 80% of the shortening and lengthening contraction intensity (P < 0.01). In the shortening resistance training group increases were only seen at 50 and 80% of both contraction type. Volitional drive (V-wave) showed a greater increase following lengthening resistance training (57%) during maximal lengthening contractions compared to maximal shortening contractions following shortening resistance training (23%; P < 0.001). During the detraining period MVC and V-wave did not change (P > 0.05), although MEP amplitude decreased during the detraining period (P < 0.01). No changes in H-reflex were found pre to post resistance training or post detraining. Modulation in V-wave appeared to be contraction specific, whereby greatest increases occurred following lengthening resistance training. Strength and volitional drive is maintained following 2 weeks detraining, however corticospinal excitability appears to decrease when the training stimulus is withdrawn.

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Limb salvage following snakebite using acute limb shortening and secondary lengthening.

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