Arch Hand Microsurg.  2024 Mar;29(1):40-45. 10.12790/ahm.23.0040.

Surgical treatment of high-pressure injection injuries of the hand caused by using paint guns: a report of three serial cases

• Jeong J
• Chung CH
• Chang Y
• Kim K
• Jung S

• KMID: 2553170
• DOI: http://doi.org/10.12790/ahm.23.0040

Abstract

The incidence of high-pressure injection injuries is increasing with the development of industry and use of injectors. Although high-pressure injection injuries are relatively rare, they commonly lead to complications such as skin necrosis, infection, and amputation. Moreover, the initial presentation is prone to be underestimated because of the small entry point at the patient’s first encounter in emergency care. A prompt surgical intervention is required, with appropriate and rapid initial treatments, including broad-spectrum antibiotics and tetanus toxoid. The surgical treatment involves wide debridement for foreign material removal and subsequent reconstruction. In this case report, we present three cases we encountered and the ensuing complications. All three patients who received the same treatments are discussed in detail.

Keyword

Hand injuries; Penetrating wound; Paint

Figure

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  Fig. 1. A 59-year-old man visited with a high-pressure paint gun injury on his left hand. (A) A preoperative photograph shows a small entry point at the second metacarpophalangeal level. (B, C) Preoperative images. Computed tomography images show a 1-cm foreign body in the palmar aspect of the metacarpophalangeal joint level (B, sagittal view; C, axial view). (D) An intraoperative photograph shows that the paint adhered to soft tissues. (E, F) Postoperative photographs. (E) The wound was sutured with a drain insertion. (F) A postoperative photograph shows completely healed wound, with no complications, and the patient exhibited almost complete recovery in his hand function at 6 months after the operation.

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  Fig. 2. A 57-year-old man who had hypertension injured his left hand by a high-pressure paint gun. (A) A preoperative photograph. Entries are shown on the left palm of the hand, first web space area, and third metacarpophalangeal area. (B) An X-ray image of the left hand. Radiopaque lesions considered as foreign bodies are seen in the first web space area. (C) An intraoperative photograph during the radical debridement with extended incisions. The whitish paint materials are seen adhering to the muscles and tendons. (D) A postoperative photograph a month after the operation. The wound had healed without any complication.

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  Fig. 3. A 63-year-old man with a high-pressure paint gun injury was referred from the Department of Orthopedics. (A) A 1-cm wound surrounded by a blackish area. (B, C) The injected paint is seen penetrating to the dorsal side of the hand. (D) An intraoperative photograph shows the arteries, nerves, and tendons that were dissected and located in the injury zone. (E–G) Photographs taken 9 months postoperative. (E) The palmar side of the hand shows a well-taken flap after a debulking procedure. (F) The dorsal side of the hand recovered with no complications. (G) The injured ring finger demonstrated functional recovery up to 90° of flexion at the proximal interphalangeal joint and 30° of flexion at the distal interphalangeal joint.

Reference

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