High-pressure injection injuries of the fingers: Long-term follow-up in patients after extensive debridement

Feldman, Guy; Rozen, Nimrod; Eliyahu, Amir; Эпштейн, А. М.; Saleem-Zedan, R.; Rubin, Guy

doi:10.1016/j.hansur.2019.07.010

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…None of the patients required amputation; thus, we can hypothesize that aggressive and thorough initial surgical debridement, even beyond 6 hours after injury, is key to optimal management of these high-pressure injection injuries. Current data support and recommend repeat debridement with 24 to 72 hours 4,13–15 . The average number of debridements observed in our study was 1.8 (ranging from 1 to 4), which is consistent with the current literature as described by Feldman et al, 14 among others 9–11 …”

Section: Discussionsupporting

confidence: 92%

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High-Pressure Injection Injuries of the Hand

Nichols¹,

Gallegos

Tavana

et al. 2021

Ann Plast Surg

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Introduction The incidence of high-pressure injection injuries of the hand is low. Although the occurrence is rare, the precarious progression of the injury exacts prompt surgical evaluation in order to avoid complications and amputation. The current study was devised in order to make comparisons to the current data, in addition to supplementing the literature with observations regarding clinical course and management. Methods A multisurgeon, retrospective chart review from a single institution was performed. Inclusion criteria included cases involving a high-pressure injection injury to the hand that underwent surgical management. Patient demographics, injury details, and hospital course were all reviewed and recorded. Results This retrospective review identified 20 cases meeting criteria, all of which involved males. The average age at time of injury was 39.7 years (range, 21–71 years). The incidence of injection injuries over a 10-year time period was 2.1 cases per year. The nondominant hand was injured in 11 cases (63%). The most common site of injury was the index finger with 11 recorded incidents (55%). Other reported locations included the metacarpal (40%) and small finger (5%). Occupational data included 10 construction workers, 5 painters, and 2 cleaning crew members, and 3 had nonmanual occupations. Paint was the most commonly injected substance with 17 reported cases (85%). On average, the delay until surgery was observed to be 21.9 hours (n = 16). Only 1 patient underwent surgery at 6 hours after surgery. The average number of procedures performed was 1.8 (range, 1–4). Hospitalization duration was on average 3.9 days (range, 1–9 days), and the average follow-up length was 69 days (range, 7–112 days). There were no identified cases that necessitated amputation. Conclusions This form of injury most commonly affects male, middle-aged laborers. Our study found very low amputation rates when compared with the current literature, despite observing longer delays to surgery according to current recommendations. Limited comparisons can be made from data regarding clinical course and management because of the small sample size of the current study and the limited published data. This indicates a need for further exploration and collection of data involving parameters such as clinical course and management.

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Section: Discussionsupporting

confidence: 92%

“…Current data support and recommend repeat debridement with 24 to 72 hours 4,13–15 . The average number of debridements observed in our study was 1.8 (ranging from 1 to 4), which is consistent with the current literature as described by Feldman et al, 14 among others 9–11 …”

Section: Discussionsupporting

confidence: 92%

High-Pressure Injection Injuries of the Hand

Nichols¹,

Gallegos

Tavana

et al. 2021

Ann Plast Surg

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“…Patients who sustain such injuries are often manual workers, and hence a good functional outcome with respect to the finger is key. In patients for whom preservation of the full length of the finger is desired, careful preoperative counselling about potential postoperative sequelae such as neuropathic pain, cold intolerance, and significant stiffness is essential [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

A Stiff Finger: A “Concrete” Diagnosis

Bateman

Roy

Kenyon

et al. 2021

Cureus

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High-pressure injection injuries of the hand are uncommon but are associated with significant morbidity and require urgent surgical intervention. We describe a case of high-pressure injection of cement into the digit of a male patient while using an airless spray gun. We outline the initial assessment and surgical intervention, patient counselling regarding definitive management, and long-term outcomes of his injury. We also discuss mechanisms of high-pressure injection injuries, reconstructive options, and present a review of outcomes in patients sustaining similar injuries.

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