High-Pressure Injection Injuries - Hand

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