High pressure injection injuries of the hand: a report of three cases

High pressure injection injury of the hand is an uncommon condition demanding early recognition and prompt surgical intervention. These three case reports illustrate the varied aetiology, pathogenesis and outcome of this condition.     

Neurovascular island flap reconstruction following high pressure injection injuries of the hand

Adequate, satisfactory treatment of high pressure paint or grease injection of the hand invariably requires wide wound excision. This results quite often in a mutilated, disabled digit or hand, with loss of soft tissue and sensation. We report two such cases, each with a neurovascular island flap used in order to restore adequate soft tissue and sensation.     

Bilateral hand reconstruction: report of three cases

Although it has been established that a single lost hand can be reconstructed by autogenous bilateral toe transplantation, the problem of how to reconstruct bilateral hand loss still remains. The authors present a novel approach to solve this intricate problem. A big toe free skin-nail flap, along with the second digital ray or second and third digital rays, with a common vascular pedicle, is taken from the donor foot and transferred to the forearm stump by microsurgical technique, thereby creating a hand with two or three digits. Either a piece of the iliac bone or an ulna block cut during the preparation of the forearm stump is used to substitute for the lost first metacarpus and phalanges of the thumb. The operative technique is described. Three patients have undergone this procedure and have had both lost hands reconstructed. Among the six reconstructed hands, two had two digits in each and the others had three digits. One reconstructed hand failed to survive subsequent to vascular thrombosis which might have been due to degeneration and thickening of the vessel wall. Partial failure occurred in another, where the transferred big toe skin-nail flap necrosed and was replaced by a pedicled skin tube. All five surviving hands were followed up for more than one year and showed satisfactory functional recovery.     

Airless paint-gun injuries of the hand: a report of three cases

Three patients were treated for airless paint-gun injuries. High-pressure paint-guns have been used by commercial painters for 20 years. The causes of the inflammation are discussed. The importance of early surgical treatment is stressed. This treatment should consist of exploration and complete excision of contaminated tissue. A satisfactory result can be obtained in most cases.     

High pressure injection injuries of the hand with surfacer

The most commonly injected materials in high-pressure injection injury to the hand include paint, automotive grease, solvents and diesel oil. High-pressure injection injuries are a frequently mismanaged problem, as they are often not recognized and treated early, which may result in a compromised function of the hand or even the amputation of a digit. Early diagnosis is an important factor, as well as the type and amount of injected material and the injection pressure at appliance. We present one case of high-pressure injection injury to the hand with the surfacer Caparol Accord. This report describes the principles of treatment and gives an overview of the literature about tissue injuries caused by components of different substances encountered in high-pressure injection injuries.     

High-pressure injection injuries of the hand.

In high-pressure injection injuries to the hand the most commonly injected materials are automotive grease, diesel oil, and paint. We treated twenty-six patients with high-pressure injection injuries of the hand and found that the injection of paint resulted in a poorer prognosis than did the injection of grease. Amputation is often necessary with paint injections into a digit, while injections into the palm have a somewhat better prognosis. The disability time of patients with paint-injection injuries appeared to be directly related to the time elapsed until amputation of the involved digit. Although we were unable to specifically relate the ultimate result to the time elapsed between injury and proper treatment, we continue to recommend early aggressive wide débridement of these injuries.     

Sterile flexor tenosynovitis of the hand: a report of three cases

Three patients presented with classic signs and symptoms of acute bacterial tenosynovitis. In each instance, the inflammatory condition was found to be sterile. The patients had no other known systemic diseases associated with sterile inflammation. Two patients had digital sheath exploration. The third patient had diagnostic digital sheath aspiration. Hand elevation, rest, and prophylactic antibiotics resulted in complete resolution in all three patients. One digital sheath biopsy specimen submitted for electron microscopy showed no evidence of a viral etiology.     

Massive craniofacial injuries from recreational fireworks: a report of three cases.

Recreational rocket injuries can result in massive destruction of facial soft tissues and bone and can produce long-term sequelae. This study reviews the cases of three patients who arrived at our medical center within a 3-week period in July 1990 who sustained severe craniofacial injuries from fireworks. A timely multidisciplinary approach is important in the care of these injuries, since there are usually associated serious ophthalmologic and cranial injuries that require immediate attention. We present the management dilemmas confronting the personnel who treat such injuries as well as tips on avoiding long-term complications.     

Treating deep-seated mycobacterium marinum infection in the hand: a report of three cases.

We report three cases of an unusual aggressive type of Mycobacterium marinum infection of the hand which had been a nightmare both for us and the patient. These were the patients in which even after repeated thorough surgical debridement and appropriate (drug sensitive) medical treatment over a period had resulted in amputation or devastation of the soft tissues so extensively that almost only the neurovascular bundle, bone and the skin were the only structures left (cosmetic fingers - no function) at the last debridement after which the infection has not recurred. By presenting this article we want to stress on certain points pertaining to diagnosis, management, varied presentation and of course the dreadful complications of deep-seated M. marinum infection.     

总结931例手外伤修复与再造的方法

目的 总结９３１例手部损伤修复与重建的方法和经验。方法 断指（肢）患者均急诊作再植术。手部皮肤缺损面积较大者作吻合血管的皮瓣移植,缺损面积较小者均选用带血管蒂的岛状皮瓣移位。拇、手指缺损者,选择游离第二足趾、Ｍｕ趾甲皮瓣、Ｍｕ趾末节移植和Ｍｕ趾背甲皮瓣移植瓦合带指神经血管蒂岛状皮瓣移位等方法再造拇手指。吻合断伤血管７９例,缝接断伤的上肢神经１０９例,在手术显微镜下修复前臂及手部肌腱４１６例。结果     

Fish vaccine injection injuries of the hand.

High pressure injection of oil-based substances can cause devastating injuries of the hand and the necessity for urgent surgical debridement has been well established. We present three cases of injection injury caused by vaccines used in the fish farming industry. Patients presented with pain, swelling and lymphangitis. The marked vascular changes often associated with such injuries were absent. All patients were treated with intravenous antibiotics combined with early surgical debridement and irrigation. We report full recovery in all three patients.     

The free fibular flap: a useful flap for reconstruction following composite hand injuries

The free fibular flap has been used extensively in facial and extremity long bone reconstruction but has not been presented as a tool for reconstruction following composite hand injuries, in particular for reconstruction of the ulnar border of the hand. We present a case of the use of this flap for reconstruction of such a complex composite hand injury.     

High pressure injection injuries of the hand a clinical,chemical and histological study

Although high pressure injection injuries of the hand are frequently described, little is known about the mechanism of tissue necrosis. A case is described which led to digital amputation and the clinical features are discussed in relation to others reported. The digit was examined histologically and a sample of liquid drained from the palm was subjected to organic chemical analysis. The findings of widespread vessel thrombosis, absence of fat from fat loculi, and coagulative necrosis of skin and subcutaneous tissue becoming less marked the more proximal in the digit suggest a chemical inflammatory cause. This is supported by chemical analysis revealing a fat solvent as the chemical agent and fat degradation products in the palmar liquid.