- Discusion:
- high pressure grease and paint guns are most common cause of injury, & site of injury is often the pad od the thumb or index finger;
- severity of injury is often underestimated due to the small punctate entrance wound;
- injected substance passes rapidly thru the subcutaneous tissue and enters the flexor tendon sheath;
- from there it passes into one or more of the deep spaces of the hand;
- thumb and index finger conduct substances into
thenar space;
- long, ring, and little fingers conduct injected material into the
midpalmar space;
- these 2 spaces may communicate each other, & they also refer material proximally into
Paron's space;
- all three spaces are deep to the profundus tendon;
- incidence: paint: 60% vs grease: 25%
- patient profile:
- young male;
- new job;
- non dominant hand (75%)
- prognostic factors:
- material injected:
- grease (fibrosis)
- paint (necrosis)
- paint causes an immediate tissue necrosis that persists if the tissues are not completely debrided;
- pressure:
- 3,000-10,000 psi;
- < 7,000 psi - non prognostic
- > 7,000 psi - 100% amputation
- site of injection:
- digits: tendon sheath - poor prognosis
- palm: not governed by fascial planes, better prognosis;
- Treatment:
- opening of fingers along nonpinch, nonprotective border surfaces;
- dorsal thumb web space incision to debride the thenar space
- midpalmar incision to open the midpalmar space;
- incision may be extended proximally to include carpal tunnel;
- w/ paint gun injury, it is essential that all paint be immediately removed from the wound and especially around the digital arteries;
- in general, wounds should be left open for serial debridement;
-
amputation:
- early amputation: consider with severe paint injection to a digit;
- consider sympathetic blocks;
High-pressure injection injuries of the hand.
High-pressure injection injuries of the hand: review of 25 patients managed by open wound technique.
The fascia of the distal phalanx.
The acute pathologic changes of paint injection injury and correlation to surgical treatment: a report of two cases.
JM Failla MD and MD Linden MD.
J. Hand Surg. Vol 22-A. 1997. p 156.
High-pressure injection injuries to the upper extremity: a review of the literature.
The surgical treatment and outcomes of high-pressure injection injuries of the hand.
