Upper extremity high-pressure injection injuries with paint thinner: Case reports with review of the literature

Introduction: High-pressure injection injuries are rare traumas of upper extremity which can result in high morbidity incompatible with presentation. Clinical presentation right after the injury can be misleading and might cause underrating of the condition. This may lead to latencies in treatment and might worsen the final prognosis of the patients. Prognosis changes according to the material injected, pressure the material is injected, injection site, and time between the injury and the onset of treatment. Digit amputation rates are between 16% and 48% in literature series, and this seems to decrease with early debridement. Materials and Methods: Emergency department referrals are searched retrospectively for patients with high-pressure injection injuries. Four patients were found that were treated for injured with high-pressure injection gun with paint thinner or mixtures. Relevant literature was searched and discussed. Results: Three out of four patients needed amputations (75%). Two patients needed flap surgery for reconstruction: one interpolation and one free flap. The average time from hospitalization to definitive operation was 9.5 days (minimum 6, maximum 15 days). Fingertip injuries resulted in amputations, and amputation level was more proximal than the injury level which was connected to the dissemination of the injected material. Discussion: High-pressure injection injuries can cause devastating results if neglected, and can be overlooked with inexperienced eyes. Usually, there are minimal complaints from the patients on the onset of the injury, but symptoms exacerbate by time. Early debridement in the first 6 h is crucial for lowering amputation rates. Injected material has a great impact on the outcomes, and organic solvents such as paint thinner, paints, diesel, and engine oil have worse outcomes and higher amputation rates. Conclusion: High-pressure injection injuries need emergency surgical intervention and should not be neglected. Delay in treatment of these cases could cause detrimental outcomes.