The anatomy of experimentally produced high-pressure injection injuries of the hand

Abstract

CONCLUSIONSSet against the vast experience, the careful documentation, and the brilliant writings of such as Gordon Taylor (1953) and Ogilvie (1944a, b) in World War 11, the series we have described appears slight. We have felt it worthy of record in that each campaign has some peculiarities and, moreover, it is rare to find younger surgeons familiar with the literature of war. Battle surgery continues to evolve although at a slower pace than previously; we have attempted to outline some of the factors which made it in 1967 more easy in some respects, but more difficult in others, than it was a quarter of a century ago. It is to be hoped that others will supplement our experience and confirm or confute the methods we have used.Acknowledgements.-It is a pleasure to record our thanks to the nursing sisters whose skill and devotion in operating theatre and acute care ward contributed so much to the survival of our and their patients; to Dr. M. J. Robinson, the team's paediatrician, who supported our surgical efforts in many directions; to Mr. R. Lawson and Mr. M. Smith for permission to include patients treated by other surgeons in the team; to Mr. Graeme Grove for much encouragement, and to the members of the Walter Reid Surgical Research Team and 3rd United States Army Surgical Hospital for stimulating advice and information.

High-Pressure Injection Injuries in the Hand

“…The wax commonly was found along the neurovascular bundles. 8 Following the initial insult, infection can play a role in further tissue destruction. The risk of infection is increased secondary to ischemia and tissue necrosis.…”

High-pressure water injection to the neck

“…2 Kaufman injected wax at 750 psi into various sites in cadaver hands demonstrating that injection Injury Extra (2006) 37, 430-431 www.elsevier.com/locate/inext of material into the membranous portion of the tendon sheath caused the injected substance to travel as far as the elbow. 6 Paint solvent injection injuries to the hand result in amputation in 60-80% of cases. Grease injection may cause fistulas, fibrosis and olegogranuloma formation but is associated with a lower amputation rate.…”

High pressure paint injection injury of the hand

“…It has been suggested that injections over the membranous portions of the flexor sheath enter the sheath readily, whereas injections over the fibrous portion do not breach the sheath but track along tissue planes and neurovascular bundles. 4 Several mechanisms are involved in the pathophysiology. The jet velocity of the equipment is governed by working pressure, nozzle diameter and injectant viscosity.…”