The acute pathologic changes of paint-injection injury and correlation to surgical treatment: a report of two cases

Optimal Irrigant in High Pressure Paint Injection Injuries of the Hand

High pressure injection injury to the hand with paint leads to amputation rates near 48%. Historically, authors utilized saline irrigation alone, but have high reoperation rates. We conducted a cadaveric study to determine the ideal detergent for effective paint removal from the soft tissue.

A unique case report of a high-pressure paint injection injury of the hand with associated carbapenemase resistant Pseudomonas aeruginosa infection

High pressure injection injuries to the hand should not be taken lightly as urgent surgical debridement is required to ensure favorable outcomes. Empiric antibiotic administration is recommended; however, few studies focus on the secondary infection risk associated with these high pressure injection injuries. We present a rare case of a patient presenting with carbapenem resistant Pseudomonas aeruginosa following a high pressure paint gun injury of the thumb. Urgent surgical debridement with administration of broad-spectrum antibiotic coverage for both gram-negative and gram-positive bacteria is recommended. The injection of foreign materials can cause extensive tissue damage and immunosuppression facilitating growth of opportunistic bacteria that are often rare in healthy adults. We advocate for obtaining cultures at initial debridement to optimize treatment in these unique and rare injection injuries. Concerns should be raised as carbapenem resistant bacteria become more prevalent in the community.

High-pressure injection injuries to the hand: A 14-year descriptive study

Background:

High-pressure injection (HPI) injury is an unusual type of injury in hand trauma, which could lead to a serious morbidity. We aimed to assess the clinical presentation, management, and outcome with HPI injury of the hand.

Methods:

A retrospective study was conducted between 2001 and 2015 for patients with HPI injuries who were admitted to a Level 1 trauma center. We reviewed the medical records, imaging files, and demographic data including gender, age, mechanism of injury, and site of hand injury. The kind of injected materials, time to first treatment procedure, clinical management, and complications were also described.

Results:

A total of 32 cases of HPI injuries were included in the study. The average age of the patients was 32.7 ± standard deviation 8.3 years, and all the patients were right handed. The most common material involved was grease (53%), followed by paints (25.0%), chemicals (9.4%), and air (6.3%). The most commonly affected part of the hand was the palm (31.3%), followed by index finger (25.0%). The average delay in the presentation was 12 h (range 3–96 h), and the mean hospital stay was 5.8 days. Management included debridement (90.6%) or conservative treatment (9.4%). Complications included chronic pain (9.4%), followed by amputation (3.1%).

Conclusions:

HPI injury is not uncommon, usually underestimated, and needs more community awareness, particularly laborers. Delay of treatment could increase the risk of amputation. Therefore, it is important to inform the risk groups about the seriousness of such injuries and to take preventive measures.

High-pressure Injection Injuries of the Hand

High-pressure injection hand injuries are often overlooked, with severe complications owing to the acute inflammatory response. Prognosis for depends on the type of material injected, location of injection, involved pressure, and timing to surgical decompression and debridement. Acute management involves broad-spectrum antibiotics, tetanus prophylaxis, emergent decompression within 6 hours, and complete removal of the injected material. Most patients have residual sequelae of stiffness, pain, sensation loss, and difficulties in returning to work. The hand surgeon's role is prompt surgical intervention, early postoperative motion, and education of patient and staff regarding short- and long-term expectations.

High-pressure injection injury in a furniture repairman--an outwardly minor injury with the potential for a devastating outcome

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney. Inquiries and contributions to the Forum should be forwarded to Joseph J. Schwerha, MD, MPH by e-mail at schwer@pitt.edu.

Latex paint-gun injuries of the hand: are the outcomes better?

This study aims to present the functional outcome in patients who sustained paint-gun injuries to the hand with latex paint and review the current trends, recommendations, and pitfalls of surgical treatment in contemporary literature. Five male patients with an average age of 35 years were treated between 2000 and 2003 after sustaining a paint-gun injury with latex paint. All wounds were located volarly on the digits of the nondominant hand. Preoperative radiographs were obtained in every patient. All patients underwent debridement of the affected digit. Despite delayed presentation, more than 24 h post injury, our patients recovered substantial function at an average follow-up of 12 months. Every patient returned to his previous occupation and there were no amputations. Paint-gun injuries with latex paint appear to be associated with an outcome that is superior to the poor outcome traditionally associated with oil-based paints.

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

OBJECTIVES

The purpose of this review was to identify the relative impact of injected material, location of injury, time to debridement, injection pressure, infection, and the use of adjuvant steroid medication upon the need for amputation after high-pressure injection injuries to the upper extremity.

DATA SOURCES AND STUDY SELECTION

A Medline literature search extending from 1966 to December 2003 was performed, referencing the key words "high-pressure injection injury," "grease gun injury," "paint gun injury," "pressure gun injury," and "high-pressure injection." The results were limited to the English language and to reports involving human subjects. Each abstract was reviewed to confirm that the described injury had occurred in the upper extremity and that it had truly been a high-pressure injection. The reference pages from each of the papers were reviewed to identify additional reports of high-pressure injection injury. Manuscripts describing injuries resulting from hand held syringes or other low-pressure mechanisms were excluded.

DATA EXTRACTION

All of the manuscripts were analyzed to identify the clinical outcome, age, hand dominance, site of injection, substance injected, injection pressure, elapsed time to wide debridement, use of steroids, and incidence of infection. These variables were subjected to a Pearson chi test to determine their impact upon the need for amputation.

RESULTS

Four hundred thirty-five cases of high-pressure injection injury to the upper extremity were identified. The amputation rate after these injuries was 30%. The location of the injury and the material injected contributed significantly to the need for amputation. For injections of paint, paint thinner, gasoline, oil, or jet fuel (organic solvents), the amputation risk was lower if wide surgical debridement occurred within 6 hours of injury. Steroids did not impact the amputation rate or incidence of infection. The presence of infection did not affect the incidence of amputation.

CONCLUSIONS

The risk of amputation after high-pressure injection injury to the upper extremity is highest with organic solvent injection into the fingers. Injections into the thumb or palm result in a much lower frequency of tissue loss. Emergent surgical debridement reduces the amputation risk after injections of organic solvents. From the available data, no conclusions could be reached regarding functional outcomes, other than amputation, after high-pressure injection injury.

Fibrohistiocytic tumor of the hand after high-pressure paintgun injury: 2 case reports

Injections from high-pressure, airless paintguns are uncommon industrial accidents that may result in acute injuries, usually to the nondominant hand. These injuries commonly require emergent management including immediate surgical debridement to avoid tissue necrosis and loss of hand function. Rarely oleogranulomas and squamous cell carcinoma have been described as late complications. Herein we describe 2 patients who developed fibrohistiocytic tumors several months after a high-pressure paintgun injury.

High-pressure injection injuries to the hand

High-pressure injection injury hides the true extent of the lesions behind an apparent small and harmless puncture of the finger or the hand. Through clinical description, we wish to point out the need for prompt treatment to avoid mutilating and function-threatening complications. We wish to outline the role of the emergency physician who must be aware of the incidence of high-pressure injection injury and become accustomed to early referral to a surgeon, experienced in extensive surgical exploration, removal of foreign bodies, and rehabilitation. The open-wound technique gives the best results. We also point out that failure to refer may become an increasing focus of negligence claims.