Updated: 12/12/2016

High-Pressure Injection Injuries

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Introduction
  • Characterized by extensive soft tissue damage associated with a benign high-pressure entry wound
  • Epidemiology
    • demographics
      • most common in laborers in industry using paint, automotive grease, solvents and diesel oil
    • location 
      • the non-dominant index finger is the most commonly affected 
  • Pathophysiology
    • force delivered from 3,000 to 10,000 PSI and up to 400mph
    • leads to dissection along planes of least resistance (along neurovascular bundles)
    • vascular occlusion may lead to local soft tissue necrosis
  • Prognosis
    • Up to 50% amputation rate for organic solvents (paint, paint thinner, diesel fuel, jet fuel, oil)
    • severity of the injury is dependent on
      • time from injury to treatment  
      • force of injection
      • volume injected
      • composition of material
        • grease, latex, chloroflourocarbon & water based paints are less destructive
        • industrial solvents & oil based paints cause more soft tissue necrosis
Presentation
  • History
    • important to document duration since event
  • Physical exam
    • inspection
      • entry wound often benign looking
      • vascular occlusion may lead to local soft tissue necrosis
Imaging
  • Radiographs
    • may be useful to detect spread of radio-opaque dye
Treatment
  • Nonoperative
    • tetanus prophylaxis, parenteral antibiotics, limb elevation, early mobilization, monitoring for compartment syndrome
      • indications
        • for injection of air and water
  • Operative  
    • irrigation & debridement, foreign body removal and broad-spectrum antibiotics 
      • indications
        • most cases require immediate surgical debridement 
      • technique
        • it is important to remove as much of the foreign material as possible
        • broad spectrum antibiotic coverage is important to reduce risk of post operative infection
      • outcomes
        • higher rates of amputation are seen when surgery is delayed greater than 10 hours after injury
Complications
  • Amputation 
    • amputation rates approach 50% with oil-based paint injection injuries
  • Infection
    • necrotic tissue is a good culture medium for bacterial growth
 

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Questions (4)

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(OBQ13.48) A 36-year-male was using a high-pressure paint gun when he suffered the injury shown in Figure A. Which of the following variables would have the worst impact on his prognosis? Review Topic

QID: 4683
FIGURES:
1

Delay in surgical treatment

77%

(4474/5814)

2

Injected solvent was grease

19%

(1088/5814)

3

Injected solvent was water-based paint

2%

(137/5814)

4

An entry wound of greater than 3 cm

1%

(85/5814)

5

Injected solvent was at room temperature

0%

(8/5814)

L 2

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(OBQ10.97) A 42-year-old male diesel mechanic presents to your clinic 3 days after he was power washing automotive parts with a high-pressure solvent and accidently hit the tip of his finger with the spray gun. A clinical photo is shown in Figure A. What is the most appropriate first line of treatment? Review Topic

QID: 3191
FIGURES:
1

Irrigation and debridement at the bedside using a digital block

1%

(29/2017)

2

Immediate debridement in the operating room

96%

(1931/2017)

3

A dose of IV antibiotics in the ER, followed by a 10 day oral course

1%

(23/2017)

4

Immediate finger tip amputation

1%

(20/2017)

5

Arrange for follow-up with a hand specialist

0%

(5/2017)

L 1

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ARTICLES (4)
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