The role of a systematic second look at 48-72 hours in high-pressure injection injuries to the hand: a retrospective study

• Published in: Chirurgie de la main 2012-10, Vol.31 (5), p.250-255
• Main Authors: Chaput, B, Nouaille de Gorce, H, Courtade-Saïdi, M, Apredoaei, C, Rongières, M, Chavoin, J-P, Grolleau, J-L, Garrido, I
• Format: Article
• Language: fre
• Subjects: Adult; Amputation; Debridement; Finger Injuries - etiology; Finger Injuries - pathology; Finger Injuries - surgery; Humans; Inflammation - etiology; Male; Middle Aged; Necrosis; Paint - adverse effects; Pressure - adverse effects; Prognosis; Reoperation; Reproducibility of Results; Retrospective Studies; Second-Look Surgery; Thumb - injuries; Thumb - pathology; Thumb - surgery; Time Factors; Treatment Outcome; Wounds, Stab - complications
• ISSN: 1769-6666
• DOI: 10.1016/j.main.2012.07.001

Poorly standardized, the management of high pressure injections (HPI) is frequently too late and inadequate, some teams reporting up to 50% of amputations. HPI causes inoculation of toxic particles in depth, particularly difficult to remove surgically. The persistence of this foreign material maintains local inflammation and increases the risk of infection. The objective of this article is to validate the benefit of a systematic "second look" at 48-72 hours in HPI. We conducted a retrospective study from 2006 to 2010, of patients who had a HPI into the hand. All patients had initial debridement surgery and a "second look" was systematically performed at 48-72 hours. During this period, six patients were treated for a HPI of paint (n=4) or oil (n=2). The time between the accident and surgery was 12.4 hours (2-24). Four patients had good functional outcome with no disabling sequelae. We performed two amputations. At six months, five patients returned to work. Early management determines the prognosis of the HPI. Extended debridement within six hours showed a better functional outcome than later treatment. Performing a systematic "second look" allows further washing/debridement and gives the possibility to be more conservative during the initial procedure. This second debridement allows excision of the newly formed necrosis and to evacuate the remaining toxic residues. Finally, patients reported good functional outcome.