Figure 1: A: Situation of the wound at admission in emergency room. B, C: Local tissue necrosis due to lytic effect of cobra venom. B: Necrosis in situ; note the greenish-yellow color of the lytic tissue; C: Necrosis after excision on sterile gauze. D: Situation of the wound after excision of necrotic tissue at the dorsum of the hand and temporary coverage with Epigard® (Biovision GmbH, Ilmenau, Germany). E, F: Defects after definite coverage with an ALT-flap. E. Dorsal view, F: Side view.