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High pressure injection injury of the hand

· medicine,Orthopedic Surgery,Nabil Ebraheim

High pressure injection injuries typically occur to the index finger or to the palm of the hand from lack of experience or misuse of paint spray, guns or grease guns. These kind of injuries require prompt surgical intervention with surgical debridement of all ischemic tissue.

The size of the wound is usually small and often underestimated. Puncture of the tissue from high pressure paint gun is worse than grease and should be treated as a limb threatening injury. The paint will cause immediate tissue rejection and necrosis. Injection pressures are usually high and more than 7,000 psi will cause 100% amputation. Injected substance passes rapidly through the subcutaneous tissue and enters the flexor tendon sheath.

The material is usually accidently injected into the non-dominant hand. Injection is typically spread either to the thenar space, midpalmar space, or may go proximally into the Parona’s space.

Injection of the digit will have a worse prognosis than the palm. Paint is the worse material and may result in over 60% amputation rate. Urgent treatment is necessary to save the limb.

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