gms | German Medical Science

Objectives/Interrogation: This trauma is potentially devastating for the hand. Usually the initial benign appearance of the wound can lead to underestimate the injury and then to delays in diagnosis and adequate treatment sometimes due to lack of common knowledge of the seriousness of this injury.

We compare our experience with what comes from literature, in order to get useful tips and tricks for the management

Methods: On between 2004 and 2014, we treated 25 patients suffering high pressure injuries. We reviewed all in 2018, 4 patients were lost to our review.

The materials injected were: in 8 patients oil, in 4 paint, in 3 grease, in 2 air, one sand and one water.

10 patients underwent surgery within 6-12 hours; other 10 underwent delayed surgery because they were seen after several days up to 30 days from trauma; one patient was treated conservatively for a subcutaneous emphysema of the right emysoma.

The age was in a range from 22 years to 62 years with a predominance of patients in their thirties.

The most affected site was dominant hand.

The mean hospitalization time was from 1 to 9 days.

All patients submitted large spectrum intravenous antibiotic therapy.

Surgery included a common time of early and aggressive debridement followed by several surgical procedures as well as tenolisys and decompression of the anatomical structures involved, reconstructive techniques with pedicled flaps (9 times) up to not rare amputations 2 cases.

Outcome was assessed by clinical examination and return to funcional and working activities, patient's satisfaction rate, DASH score

Results and Conclusions: 9 patients had a return back to normal working activity; 4 patients were unsatisfied; 1 patient took long neurological discomfort over 2 years;7 report mild functional recovery. Dash score was 6,2.

We can assess that the prognosis depends on several important factors: latency time, toxicity of the material injected, site of lesion, age of the patient, aggressive and prompt surgery. On our hands, the most important keys are: prompt diagnosis, early surgery, with a wide exploration, accurate debridement with detection of all the damaged tissue, and reconstructive surgery with flaps or tendon or skin graft; of course. Antibiotic therapy, the possibility of repeated or secondary surgery and early and intensive physiotherapy, are required and patients should be informed about possible poor prognosis.