Arch Hand Microsurg.  2019 Sep;24(3):225-233. 10.12790/ahm.2019.24.3.225.

Outcomes of Neglected Paint Gun Hand Injuries: Neglected Patients

• Shin HS
• Cha SM
• Shin HD

• KMID: 2456246
• DOI: http://doi.org/10.12790/ahm.2019.24.3.225

Abstract

PURPOSE
We report a retrospective case series of patients who received delayed treatment for a paint gun hand injury.
METHODS
From January 2001 to December 2016, 13 patients injured from the fingertip to the wrist and treated surgically after a 48-hour delay was evaluated. Basic demographic characteristics, injury mechanism, lesion, time-to-surgery, and degree of injury were investigated. The visual analogue scale (VAS) scores; Disabilities of the Arm, Shoulder, and Hand (DASH) scores; and Strickland evaluations were analyzed at least 2 years after injury.
RESULTS
The surgery was performed at a mean 59.7 hours after injury. Soft tissue coverage was performed at a mean 8.2 days after the initial incision and debridement, and simple skin closure and full-thickness skin grafting were performed in 1 and 7 patients, respectively. Moreover, cross-finger flap, neurovascular island flap, retrograde island flap, and groin flap were used in one, one, one, and two patients, respectively. The mean follow-up period was 28.2 months, and the mean VAS and DASH scores were 0.92 and 36.3, respectively, whereas the outcomes of the Strickland evaluations were "˜good' in two patients, "˜fair' in seven patients, and "˜poor' in four patients.
CONCLUSION
The recent mechanical development of paint guns has led to an increase in high-pressure injection injuries and resulted in greater accidental toxic paint injection into the fingers and hand. Thus, the toxic and inflammatory response progresses rapidly to acute compartment syndrome and necrosis, and delayed treatment is therefore associated with poor clinical outcomes.

Keyword

Paint; Gangrene; Flap

MeSH Terms

Arm
Compartment Syndromes
Debridement
Fingers
Firearms
Follow-Up Studies
Gangrene
Groin
Hand Injuries*
Hand*
Humans
Necrosis
Paint*
Retrospective Studies
Shoulder
Skin
Skin Transplantation
Wrist

Figure

• 

  Fig. 1 (A) A 44-year-old male (patient 7) sustained an injury to his index finger. On a repeat visit 78 hours after the accident, the volar area of the index finger was found to be partially necrotized. (B) Paint had invaded both sides of the synovium of the flexor and extensor tendons and was subsequently removed thorough debridement. (C) Paint had invaded both sides of the synovium of the flexor and extensor tendons and was subsequently removed thorough debridement. (D) Two-thirds distal to the proximal interphalangeal joint of the index, except for the bone and tendon, were deficient. (E) Groin flap was performed 8 days after the initial debridement. (F) At the 32-month follow-up appointment, the outcome was ‘fair’ according to the Strickland method.

• 

  Fig. 2 (A) A 40-year-old male (patient 10) was injured in the first web. On a repeat visit 60 hours after the paint gun injury, a pin-point lesion was observed, and there was leakage of paint. (B) Paint had invaded both sides of the flexor and extensor tendons and was subsequently removed by several thorough debridements. (C) Paint had invaded both sides of the flexor and extensor tendons and was subsequently removed by several thorough debridements. (D) Fortunately, the lesion healed without any soft tissue defect. At the 30-month postoperative follow-up appointment, the outcome was ‘fair’ according to the Strickland method.

• 

  Fig. 3 (A) A 42-year-old male (patient 4) sustained an injury to his thumb. On a repeat visit 50 hours after the accident, gangrene had proceeded into the thenar muscles, whereas the inflammatory response had extended proximal to the wrist. (B) A 42-year-old male (patient 4) sustained an injury to his thumb. On a repeat visit 50 hours after the accident, gangrene had proceeded into the thenar muscles, whereas the inflammatory response had extended proximal to the wrist. (C) The distal phalanx was completely necrotized, and the remnant thumb was subsequently covered by a groin flap. (D) The distal phalanx was completely necrotized, and the remnant thumb was subsequently covered by a groin flap. (E) At the 24-month postoperative follow-up appointment, the outcome was ‘fair’ according to the Strickland method.

• 

  Fig. 4 (A) A 45-year-old male (patient 12) sustained an injury to his long finger. Except for the fingertip, two thirds of the volar just distal to the proximal interphalangeal joint was debrided. (B) The defect was covered using a homodigital reverse island flap at 6 days after the initial surgery. (C) The defect was covered using a homodigital reverse island flap at 6 days after the initial surgery. (D) The defect was covered using a homodigital reverse island flap at 6 days after the initial surgery. (E) At the 32-month postoperative follow-up appointment, the outcome was ‘poor’ according to the Strickland method.

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