Effects of a negative pressure venom extraction device (Extractor) on local tissue injury after artificial rattlesnake envenomation in a porcine model

Objectives. - To determine if a commercially available negative-pressure venom extraction device (Extractor) reduces local tissue injury after artificial rattlesnake envenomation in a porcine model. Methods. - We prospectively studied 10 pigs using a crossover design. After the pigs were anesthetized, 25 mg Crotalus atrox venom was injected obliquely with a 22-gauge needle 7 mm deep into subcutaneous tissues proximal to the ventral hind hoof. Pigs were randomized to receive either the Extractor (applied 3 minutes following envenomation and left in place for 30 minutes) or no Extractor. The protocol was repeated 14 days later by using the alternate treatment group and opposite hind leg for each animal. We measured leg circumference at standardized locations on the hoof, foreleg, and thigh at baseline and then 1, 2, 3, 4, 5, 6, 24, 48, 72, and 96 hours following venom injection. Maximal changes in circumference at 6 hours were compared using the paired t test. Minimum residual swelling at up to 96 hours was similarly compared. Results. - Maximal 6-hour swelling was similar with and without the Extractor: the hoof difference with the Extractor was -0.1% (95% CI = -3.4% to 3.2%, P = .95), foreleg difference was 0.3% (95% CI = -4.1% to 4.7%, P = .88), and thigh difference was -2.8% (95% CI = -10.0% to 4.4%, P = .40). Minimum residual swelling at up to 96 hours was also similar with and without the Extractor: hoof difference with the Extractor was 1.2% (95% CI = -5.6% to 8.0%, P = .70), foreleg difference was 0.6% (95% CI = -3.7% to 4.9%, P = .76), and thigh difference was 0.3% (95% CI = -2.4% to 3.0%, P = .81). A circular lesion identical in size and shape to the Extractor suction cup, which later necrosed and resulted in tissue loss, developed where the device had been applied in 2 animals. No such lesions occurred in legs not treated with the Extractor. Conclusion. - No benefit was demonstrated from Extractor use for artificial rattlesnake envenomation in our animal study. The skin necrosis noted in 2 Extractor-treated extremities suggests that an injury pattern may be associated with the device.