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EM@3AM: High-Pressure Injection Injury

High pressure injection injuries are associated with high morbidity. Devices which spray liquids at high pressure can inject foreign material deep into soft tissue. This causes an inflammatory response and fibrosis which varies based upon the material injected. Paint and paint thinner cause an earlier, more intense inflammatory response and result in a high number of amputations. Grease injuries, on the other hand, cause a less intense inflammatory response and fewer amputations, but more often cause granuloma and fistula formation with loss of function. Symptoms may be minimal immediately after the injury but swelling, vascular compromise and tissue necrosis develop in a matter of hours.

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 High-pressure injection injury of the hand: an often underestimated trauma: case report with study of the literature

High-pressure injection injuries to the hand are characterised by a small and punctiform skin lesion but with severe subcutaneous damage of the tissues. The initial clinical presentation can be misleading as a result of which an adequate treatment is frequently postponed. In the first place an intoxication caused by the fluid must be excluded. The surgical treatment must happen under complete anaesthesia or plexus block. An immediate wide microsurgical exploration must be carried out with complete debridement of the foreign material and necrotic tissue. If there is no immediate intervention, additional damage occurs, with a decrease of the functionality of the hand.

Articles of Interest

High-Pressure Hand Injection Injury Case Report

These injuries are important to recognize because the initial injury can involve damage to ligaments, tendons, and neurovascular structures.1-5 Pressure increases, from the injected material and subsequent tissue swelling, can result in vascular injury and compartment syndrome.

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StatPearls

High-pressure injection injuries of the hand occur when the hand comes into contact with the nozzle of a high-pressure injecting system such as a paint gun or air compressor. The material injected can traverse from the hand to the forearm and upper arm.