Abstract
Chronic ulceration following snake-bite envenoming is a severely disabling and therapeutic challenge, often refractory to multiple treatment modalities. We report the successful management of a non-healing pedal ulcer, 30 years in duration, on the left lower limb of a 53-year-old man, secondary to a viper bite. The ulcer had a three-decade history of recurrence despite various treatments, including a failed surgical skin graft 15 years earlier. Upon presentation, extensive workup ruled out vascular insufficiency, infection, osteomyelitis, and malignancy. A wound biopsy confirmed chronic inflammation, leading to a diagnosis of a chronic inflammatory ulcer. Management focused on suppressing the underlying inflammatory drive. The patient was started on a course of anti-inflammatory therapy with deflazacort and colchicine, alongside standard wound care and pain control. Over eight months, the inflammation subsided, and healthy granulation tissue formed. While maintaining anti-inflammatory cover, a split-thickness skin graft was performed, which was entirely successful. The patient was successfully weaned off medications and remains ulcer-free at one-year follow-up. This case highlights that the key to managing such longstanding, refractory ulcers lies in recognizing and targeting the persistent chronic inflammation over an extended period before attempting surgical reconstruction. This novel strategy of prolonged medical therapy to create a conducive wound environment was critical to the success of the skin graft, in which all previous interventions had failed, offering a potential new paradigm for managing this challenging sequela of snake bite.