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High Pressure Injection Injuries in the Hand

- 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

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.