Insecticide injection injuries to both hands: A case report

Surgical decompression of both handswas then performed. The SUbcutaneous dorsa of both hands contained large amounts of necrotic fat, which extended along the dorsal vessels, tendons, and nerves. On the right hand a central area of dorsal skin was debrided (Fig , 2). There was bilateral necrosis of the interosseus muscles. Both hands were debrided and irrigated, the wounds were dressed and splinted, and a cephalosporin antibiotic was administered intravenously. Active and passive range-of-motion exercises were begun on the first postoperative day. A psychiatric consultation was obtained, and treatment was instituted. Two days later the patient returned to the operating room for a second irrigation and debridement. One week later the defect on the dorsum of the left hand had closed primarily except for a small area, which was treated with a skin graft. Exploration of the right hand demonstrated persistent spasm of the radial artery, which precluded its use as the recipient of a free tissue transfer or a distally based radial forearm flap. Therefore reconstruction was accomplished with a pedicled groin flap. The pedicle was divided 3 weeks later (Fig. 3).