Injection Injuries
Martin I. Boyer
Definition: The inadvertent introduction under pressure of paint, grease, oil, or other liquid into the fingers or the hand leading to local superficial and deep tissue necrosis, vascular and neurological embarrassment, and an urgent/emergent need for surgical assessment and treatment.
High-pressure injection injuries of any liquid (organic, inorganic, or water soluble) is an indication for an emergent surgical consultation for the consideration of possible incision, drainage, debridement, and irrigation. These surgical treatments may need to be repeated several times over a short period of time (sometimes daily) in order to achieve adequate wound toilet. Following debridement, provision of soft tissue coverage in the form of either skin grafts or flaps (local or distant) may be necessary.
Pathogenesis
Both local pressure effects on tissue perfusion and direct tissue destruction from the noxious injectate are etiologic in tissue destruction. A secondary inflammatory reaction to the presence of paint or lubricating oils injected under high pressure has been cited as well in ongoing tissue damage.
Patients at their job less than 6 months are represented highly in this group of patients
Factors related to outcome
Injection into fingers do more poorly than injections into the palm.
Paint injections do more poorly than oil or grease injections.
Volume of injectate may be related to a poorer outcome.
Early surgical treatment may not necessarily lead to improved outcome (Gelberman), although Stark has suggested that interval between injury and surgical treatment was a “major factor” in ultimate result.
Patients’ function is eventually better if amputations (when required) are carried out earlier in the course of treatment.
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