Diagnosis and surgical treatment of high-pressure injection injuries(HPII)of the hand

Objective To analyze the diagnosis and surgical treatment of 6 cases of high-pressure injection injuries (HPII) of the hand. Methods Six cases of high-pressure injection injuries to the hand treated from May 1997 to October 2007 were reviewed. The characteristics and treatment outcome were analyzed. ALl of these patients were male. Injured sites included index finger in 2 cases, middle finger in 2 cases, thumb in 1 case, and palm in 1 case. Oil varnish was injected in all patients. The time of admission to the hospital after trauma was 1 hour to 2 days. All cases were given surgical debridement, 2 cases were treated with direct surgical suture, 3 with secondary debridement, 1 with a third debridement. The last 4 cases with skin defect were treated with the reverse island flap pedicled on dorsal metacarpal artery and posterior interosseous artery. All cases were given systemic rehabilitation after the operation. Results All cases were followed up for 7 months to 6 years. Necrosis of finger didnt occur in any patient, and all 4 flaps survived completely. The healing time was 17 -35 days. All the patients complained cold intolerance, hypersensitivity and paresthesia within 1 -3 years after the operation. Four patients returned to their previous employment at an average 1.7 years postoperatively. Joint stiffness of the affected finger and its neighboring fingers occurred in 2 patients at postoperative year 4. Conclusion This study confirms the fact that high- pressure injection injury to the hand is a significant problem. The injury has significant impact on future function and reintegration into the work force. Standardization of the treatment regimen should be designed based on the severity of HPII. Key words: Hand injuries;  Debridement;  Surgical flaps;  HPII