High-pressure injection injuries of the hand. Pathogenesis, problems and therapy

High-pressure injection injuries are rare and the extent of tissue damage is often underestimated. They usually have devastating effects on tissues and result in poor functional outcome of the involved hand. The severity of these injuries is related to the nature, pressure, volume and toxicity of the injected substance. The major problem of this injury is a toxic edema followed by ischemia, causing a gangrene of the involved finger, which may require amputation. The pathogenesis is characterized by different, but often synchronous onsets, leading to an apparent chain of events that occur once the material has been injected. Increase of pressure within the closed space leads to tamponade, intravascular thrombosis and spasm of vessels create circulatory embarrassment, a chemical irritation provokes an acute inflammation. Three stages of progress are described. Timing is an important factor influencing the results. An early, wide decompression and aggressive debridement with complete removal of foreign substances and necrosectomy is recommended in the acute stage and will improve prognosis and outcome. Open wound treatment and second-look operations during the intermediate stage are followed by secondary wound closure with local or free flaps, if necessary. We emphasize the role of early active motion during this time. Reconstructive surgery is reserved for the late stage.43 patients were treated surgically in our department over the last 28 years (1972 to 2000). 12 of them (28 %) required amputation at different levels of the involved finger. Only nine patients healed without any functional loss. Most frequent injuries were of the paint or paint-solvent and grease-gun type.