Srey Crieat Snake Bite Victim

Srey Crieat is an old Khmer Lady who was refered to me by a friend. She lives across the road from her in a very small village community near Takmoa in Cambodia. She showed me pictures on her phone, like the one above, that were pretty shocking. We arranged to take the 100Km trip to go see her the next day.

What I found when we arrived was that the arm was in a real mess. Lots of necrosis and infection and it looked as though it had never been properly cleaned despite her spending several days in the local community clinic. Her hand in particular was in a very bad state with dead full thickness skin full of all sorts of dirt and insect eggs. First job of the day was to thoroughly clean the area and consider debridement.

The whole area was scrubbed clean using a mixture of povidone and hydrogen peroxide. She appeared not to be feeling any discomfort probably due to the invenomation damaging periferal nerves. Did not want to do too much more at this point. She was given some effective antibiotics and the hand and arm were dressed and bandaged with a plan to return ASAP to do a sharp debridement of the hand, but I did not have the correct tools with me at that point.

The dead tissue on the hand and elsewhere needed to be removed to enable the living tissue beneath to begin to clean and heal itself. Looks messy but was quite a simple procedure. Keeping things a clean as possible out in this environment was much more of a challenge. She had apparent good blood flow to the tips of her fingers despite them being quite swollen.

Dead tissue removed from the back of her hand

Early days yet, this was only the second visit with lots more work to do. Hand now dressed with a packing of pure honey as were the other areas of necrosis that had yet to be removed. They were solid and would have taken a lot of cutting which became uneccesary after 3 days soaked in honey, they softened a became partially detached making them easier to remove.