1/41. bone resorption of the proximal phalanx after tendon pulley reconstruction.A 35-year-old male worker sustained a degloving injury of the left hand. An abdominal flap was used for skin coverage. Tenolysis and reconstruction of the A2 pulley was done using a procedure based on the 3-loop technique, which was modified by putting the tendon loop under the extensor apparatus and periosteum. X-ray revealed hourglass-shaped bone resorption around the proximal phalanx, just under the reconstructed pulley. Diaphyseal narrowing remained present in follow-up x-rays obtained 9 and 10 years later. The remodeling of the resorption was poor. Too much pressure may have caused this bone resorption from the shortened pulley and the circulatory deprivation may have been caused by the dissected periosteum and blocking by the surrounding tendon loop. The degloving injury, which also deprived the digits of a blood supply, may have been an additional underlying risk factor. We recommend that future comparative studies of pulley reconstruction take into account mechanical effectiveness as well as force distribution.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/41. Free toe pulp transfer for digital reconstruction after high-pressure injection injury.We report two cases of high-pressure injection injuries to the fingertip in which free toe pulp flaps were used to resurface the palmar surface of the finger following extensive wound debridement. There was good return of sensibility and, because of the high durability of the donor skin, both patients regained good functional use of the injured digits and returned to heavy manual work. There was minimal associated morbidity of the donor sites. The free toe pulp flap represents an excellent alternative for resurfacing the digit with a large residual skin defect after high-pressure injection injury.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
3/41. subcutaneous emphysema of a digit through a pre-existing puncture wound.A case of injection of compressed air into a digit is reported. The air was injected at 50 PSI through a trivial puncture wound sustained some hours previously. The case had a benign course, in comparison to high pressure injection injuries with foreign material.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/41. Salvage of ischemic digits using a lateral arm fascial flap.Four patients underwent microvascular transfer of a lateral arm fascial flap to salvage severely ischemic digits by means of induction of neovascularization. The cause of the digital ischemia was direct trauma (crush injury) in one patient and chronic embolic phenomena (proximal arterial occlusion) in three patients. None of the patients had responded to traditional therapy, including treatment with one or more of the following: anticoagulation, lytic therapy, oral vasodilators, digital sympathectomy, and vein bypass grafting. Each patient underwent noninvasive (Doppler ultrasound, digital pressures, digital temperatures, vascular refill) and invasive (angiogram) vascular assessment preoperatively. After microvascular transfer of the lateral arm fascial flap, all patients reported symptomatic relief, and objective improvements were documented by both noninvasive and invasive assessment criteria. One patient developed a seroma at the donor site; another experienced a late complication of thrombosis of the flap after his wound dehisced. A 6-month follow-up evaluation demonstrated neovascular collateralization and stable improvement without regression in the remaining patients. The authors present their clinical experience and propose a treatment algorithm for patients with chronic digital ischemia.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/41. High-pressure silicone injection injury of the hand.A case of room-temperature vulcanizing (RTV) silicone injection of the hand is presented, and principles of management of high-pressure hand injuries are outlined. Early debridement and decompression are urgent in the acute stage of injury. Intermediate stages require adequate coverage and mobilization, and late stages involve reconstructive procedures. As in all high-pressure hand injuries, safety measures and prevention at the industrial level are very important.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
6/41. High-pressure hand injection injuries caused by dry cleaning solvents: case reports, review of the literature, and treatment guidelines.A previously unreported subset of high-pressure injection injuries, namely those involving solvents used in the garment dry cleaning industry, is presented. Dry cleaning solutions contain isoparaffinic hydrocarbons, methoxypropanol, and dichlorofluoroethane. Although these solvents have limited potential for systemic toxicity, severe local toxicity causing tissue necrosis often results in loss of the injured digit. Proper treatment includes prompt surgical exploration, careful debridement and irrigation, intravenous antibiotics, and in selected cases, high-dose systemic corticosteroids.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
7/41. Freon injection injury to the hand. A report of four cases.During a 6-month period, the poison center was consulted on three occasions for advice regarding accidental injection of hexafluorethane (Freon) used in the manufacturing process of athletic shoes. A fourth case was later identified after consulting physicians near the manufacturing facility. Little information exists in the medical literature concerning injection of freon or other volatile substances. In each of these cases, workers inadvertently injected concentrated hexafluorethane into a finger while holding the shoe component and attempting to inject hexafluorethane. Each case presented with edema, limitation of motion, and crepitation. Hand roentgenogram revealed subcutaneous gas. Treatment was nonsurgical, consisting of splinting, tetanus immunization, and antibiotics. Rapid resolution of symptoms occurred in all four cases. Hexafluorethane is relatively inert when injected and has low toxicity. However, potential rapid expansion warrants observation for pressure injury.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/41. High-pressure injection injury involving a 2-PAM chloride autoinjector.High-pressure injection injuries to the hand are often associated with severe morbidity and should be considered surgical emergencies. The severity of these injuries is usually due to vascular compromise and the inflammatory nature of the material injected, such as paint, grease, and solvents. We present a case of a high-pressure injection of 2-PAM chloride into the finger of a 3-year-old boy. In this case, operative treatment was not necessary and all symptoms resolved.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
9/41. High-pressure paint-gun injury of the finger simulating giant cell tumor of tendon sheath.High-pressure paint guns deliver paint at approximately 3000 pounds per square inch. At this pressure, paint will penetrate the skin and spread quickly through fascial planes and tendon sheaths. The present case is that of a lesion from the finger of a 35-year-old white male in whom a history was initially unavailable. Histologic examination revealed diffuse fibrohistiocytic proliferation and giant cells, with numerous darkly pigmented, uniformly small-sized particles throughout the lesion. The initial impression was that of a giant cell tumor of tendon sheath. However, the pigment particles were negative for Perls stain, and polariscopic examination revealed clear refractile fragments. These findings raised the possibility that the lesion was the result of a traumatic event. On further inquiry, it was revealed that the patient had sustained a high-pressure paint-gun injury 1 year earlier. The simulation, histopathologically, of a giant cell tumor of tendon sheath by a high-pressure paint-gun injury has not, to our knowledge, been reported previously, nor has the histologic finding of small, uniformly sized pigment particles and polarizable refractile fragments in this particular type of injury.- - - - - - - - - - ranking = 8keywords = pressure (Clic here for more details about this article) |
10/41. High-pressure injection injuries of the hand.Various types of high-pressure equipment, including airless paint sprayers, hydraulic apparatus and grease guns, are used in industry, in farming and in the home. Injection injuries from this equipment usually involve the hand and may initially appear benign. However, these injuries must be treated quickly and aggressively to prevent significant long-term disability.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
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