Although surgery should not be used as first-line treatment, immediate ablation should be performed when necrotic change around the fang mark is recognized

, v. 16, n. 1, p. 3-4, 2010. Herein, I give my response and present my considerations on why immediate radical fang-mark ablation may be effective in some cases (2). Firstly, I also believe that surgery is not the best treatment for snake envenomation, as Dr. Chippaux (1) stated in the conclusion of his letter. Appropriate first-aid treatment for fang wounds is clearly described in the booklet entitled “How to Prevent or Respond to a Snake Bite” by the US Centers for Disease Control and Prevention (CDC), where it is stated “Do not slash the wound with a knife” (3). I believe that mere slashing is of no use for reducing the injected volume of venom; conversely, it may worsen the bite wound by provoking infection and nerve or vessel injury (4).Secondly, I do not dismiss antivenom usage, as stated in our article: “Continuous observation is indispensable after ablation, and if severe systemic symptoms of envenomation occur […] antivenom treatment should be indicated with no hesitation” (2). I think this principle is the same when a patient does not undergo ablation. Thirdly, although snakebites are most commonly treated with specific antivenoms, surgical management has also been practiced. Several investigators reported that many patients required surgical debridement or amputation to treat bite wounds, subsequent to or along with conservative treatment (5-8). Wongtongkam