High-Pressure Hand Injury Follow-up

Updated: Oct 17, 2015
  • Author: Stewart O Sanford, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Follow-up

Further Outpatient Care

Outpatient management of high-pressure hand injuries is contraindicated.

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Further Inpatient Care

Extravasation of the injected material may further jeopardize the limb.

Prompt decompression and directed debridement of the nonviable tissue is an important strategy to prevent further tissue damage.

Less-aggressive therapy may have a role in injection injuries with less irritating substances (eg, Freon). [15, 16]

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Transfer

Transfer patient to a facility with a hand specialist if none is available at the receiving hospital.

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Complications

Amputation is more likely if debridement is delayed more than 10 hours, especially with low viscosity substances.

Tissues that survive the initial injection injury but still contain grease, paint, or oil heal slowly and may develop multiple oleogranulomas of varying sizes.

In time, the oleomas drain through sinuses or open directly through the skin.

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Prognosis

Factors that determine the severity of the injury include the following:

  • Type and viscosity of the material injected
  • Time interval between injury and treatment
  • Amount of material injected and velocity of the injectant
  • Pressure of the appliance
  • Anatomy and distensibility of the site of injection
  • Presence of secondary infection

Injection of irritating substances under high pressure has the potential for disability and amputation despite prompt aggressive therapy.

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