Surgical reconstruction for high-pressure injection injuries to the hand

Abstract

Introduction High-pressure injection injuries to the hand result from injection of substances by high-pressure industrial devices. These are rare lesions with high risk of substantial long-term morbidity. Tissue defects resulting from staged debridement require skin grafting or vascularized island flap coverage. Hand therapy is an important part of the complex rehabilitation of such patients. The objective is to present complex surgical reconstruction of severe high-pressure injection injury of the hand aimed at preserving limb function. Material and methods Methods and results of surgical reconstruction of a patient with severe high-pressure injection injury of the hand treated at the Research Institute – S.V. Ochapovsky Regional Clinic Hospital No.1 in 2018–2019. Results Short-term result of surgical treatment demonstrated complete skin restoration and maximum possible preservation of underlying deep anatomical structures of the hand. Subsequent surgical interventions were aimed at restoring the hand function. Conclusion The restorative treatment of a high-pressure injection injury of the hand includes the earliest possible primary surgical treatment of the wound with wide revision, maximum removal of the injected substance and non-viable tissues and prevention of secondary injuries and infection in the wound. Nonfree vascularized flaps, full-thickness free grafts or split-skin autografts are used for skin reconstruction. Restoration of other functionally significant structures can be considered at a long term with wounds healed and autografts completely implanted. Hand therapy is integral to the comprehensive functional rehabilitation of the high-pressure injection injuries to the hand.

Keywords

• wound
• hand
• high-pressure injection injury
• flap
• skin autograft
• reconstruction
• hand therapy