High-pressure injection injuries to the upper extremity and the review of the literature

Yıldıran, Gökçe; Sütçü, Mustafa; Akdağ, Osman; Tosun, Zekeriya

doi:10.14744/tjtes.2020.26751

Cited by 3 publications

(15 citation statements)

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“…In such instances, there is a correlation between shorter time from injury to surgery and improved prognosis [ 7 ]. Various literature has demonstrated amputation is not necessary with air injection injuries [ 8 , 9 ]. Also, it is indicated that although high-pressure injections are dangerous and destructive, air injections are less destructive than injections of more caustic substances and interventions such as aggressive fasciotomy and debridement should not be rushed [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Non-surgical management for air injection injury to the hand, a case report

Pipkin

Frangenberg

Wade

et al. 2022

Case Reports in Plastic Surgery and Hand Surgery

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Section: Discussionmentioning

confidence: 99%

Non-surgical management for air injection injury to the hand, a case report

Pipkin

Frangenberg

Wade

et al. 2022

Case Reports in Plastic Surgery and Hand Surgery

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“…In orthopedic hand literature, the risk of amputation increases significantly when injection injury exceeds 1,000 psi. 10 Applying the treatment paradigm used for extremities to the orbit is impossible as wide debridement of the orbit is limited. However, early involvement of an oculoplastic surgeon for orbital debridement may help to mitigate some of the delayed sequelae and preserve vision.…”

Section: Discussionmentioning

confidence: 99%

“…This has been shown to decrease the risk of amputation when these injuries occur in the extremities. 10 Alternatively, when the substance is less caustic, such as grease, amputation rates are lower and do not appear to be influenced by time to surgical intervention so surgery may be delayed or avoided. 5,6,10,11 As in this case, trending CRP can be a useful tool when deciding if further debridement is needed.…”

Section: Discussionmentioning

confidence: 99%

“…10 Alternatively, when the substance is less caustic, such as grease, amputation rates are lower and do not appear to be influenced by time to surgical intervention so surgery may be delayed or avoided. 5,6,10,11 As in this case, trending CRP can be a useful tool when deciding if further debridement is needed. An increasing CRP should raise concern for ongoing inflammation due to retained caustic substances.…”

Section: Discussionmentioning

confidence: 99%

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Severe Diesel Injection Injury to the Face, Neck and Orbit: Surgical Management and Critical Care Considerations

Dawson

Echalier²,

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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The purpose of this report is to discuss high-pressure injection injuries involving the face and orbit and discuss factors affecting prognosis and management as these injuries are rare and uniquely challenging to manage given the complex anatomy and extensive damage that may occur. In this case, we present severe injury to the left orbit, maxillofacial region, and neck of a 29-year-old male who suffered a high-pressure diesel injection injury requiring several surgical debridements, intensive care unit (ICU) level care, and ultimately sub-total exenteration. Initial management involved systemic antibiotics, steroids, and surgical debridement; however, our patient experienced subsequent rapid deterioration resulting in admission for more aggressive subspecialty intervention. Decision-making was guided by serial CT of the face and orbits, and C-reactive protein (CRP) levels in addition to the physical examination. His course was complicated by progressive extensive soft tissue necrosis requiring 8 surgical debridements and optic nerve tenting despite orbital decompression resulting in loss of the OS. Ultimately, definitive treatment required sub-total exenteration and negative wound pressure therapy over the orbit followed by eyelid reconstruction as an outpatient. We conclude that without prompt recognition and meticulous debridement, the resultant injury from high-pressure injection injuries can be devastating and lead to permanent vision loss, loss of an eye, loss of facial function, and airway compromise depending on the location of the injury. A multi-disciplinary team involving oculoplastics, otolaryngology, infectious disease, and ICU should be assembled based on the complexity of this injury and its sequela. CRP can be useful to monitor patient recovery and the need for further surgical intervention. When debridement results in complex wounds over the orbit and face, negative pressure wound therapy should be considered.

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“…While relatively rare, high-pressure injection injuries to the hand carry significant morbidity, with estimated rates of required amputation reaching as high as 48%. 1 , 2 These injuries need to be recognized immediately because studies have shown that the best outcomes occur when debridement is performed within 6 hours of the injury, and rates of amputation rise rapidly after 10 hours. 1 , 2 , 3 , 4 , 5 , 6 In addition, these injuries are typically suffered by young laborers, who would experience significant losses due to amputation or loss of function.…”

Section: Brief Introductionmentioning

confidence: 99%

A Case Report of the Rapid Evaluation of a High Pressure Injection Injury of a Finger Leading to Positive Outcomes

Hansen

Danko

2022

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High-pressure injection injuries, though rare, carry high rates of morbidity and amputation despite a potentially benign initial presentation. Emergency physicians must have a high index of suspicion and be ready to act quickly when evaluating this presenting complaint. In this case report, a patient presented to the emergency department with a chief complaint of finger pain after a pressure washer came into contact with his right index finger. He subsequently developed pain, numbness and a white discoloration to his finger surrounding a small puncture wound. Key interventions in his care included rapid assessment, beginning broad spectrum antibiotics, and quickly consulting the hand surgery team. Despite the potential for significant morbidity with this injury, expedited evaluation and treatment in this case allowed for adequate retention of function in the affected digit, with only mildly decreased pincer function. In summary, the early mobilization of resources for patients with high-pressure injection injuries, especially early surgical consultation, is paramount to achieving positive outcomes. Topics Finger injury, hand injury, high-pressure injection injury.

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High-pressure injection injuries to the upper extremity and the review of the literature

Cited by 3 publications

References 0 publications

Non-surgical management for air injection injury to the hand, a case report

Non-surgical management for air injection injury to the hand, a case report

Severe Diesel Injection Injury to the Face, Neck and Orbit: Surgical Management and Critical Care Considerations

A Case Report of the Rapid Evaluation of a High Pressure Injection Injury of a Finger Leading to Positive Outcomes

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