High-pressure injection injuries to the upper extremity and the review of the literature

BACKGROUND: High-pressure injection injuries of the hand are rare severe injuries. This study aimed to present a retrospective analysis of current and possible prognostic factors, treatment modalities and evaluation criteria.
METHODS: Ten patients who had high-pressure injection injury to their upper extremity between 2005–2018 were included in this study. All patients were evaluated for the compartment syndrome; if exists fasciotomy and wide debridement were performed. After the first debridement, the second debridement was considered within the first 24 hours.
RESULTS: In this study, 10 patients (mean age: 30) were evaluated retrospectively. The injected materials were the animal vaccine, thinner, oil, diesel, water, plastic and paint. Preoperative and postoperative mean WBC levels were 14.73 K/µL and 9.62 K/µL, respectively. Preoperative and postoperative mean neutrophil levels were 11.4 K/µL and 6.49 K/µL, respectively.
CONCLUSION: Early and serial debridement and compartment syndrome evaluation are required. Despite these cautions, amputation may occur. Material, injection force and the time elapsed are the main determinants in prognosis. Aggressive debridement is required in high-pressure injection injuries. However, the adequacy of debridement should be evaluated because it is mostly impossible to completely clean the tissue from diesel or thinner. According to the experience of 10 cases in our series, when clinical and macroscopic debridement adequacy was observed, a decrease in WBC and neutrophil levels was observed simultaneously. For this reason, WBC and neutrophil levels may be an indicator of the adequacy of debridement, although these injuries are very rare, larger series are needed for this interpretation.

Üst ekstremitenin yüksek basýnçlý enjeksiyon yaralanmalarý ve literatürün gözden geçirilmesi

AMAÇ: Elin yüksek basýnçlý enjeksiyon yaralanmalarý ciddi, nadir yaralanmalardýr. Bu yazýda, mevcut ve olasý prognostik faktörlerin, tedavi yöntemlerinin ve deðerlendirme kriterlerinin geriye dönük analizi sunuldu.
GEREÇ VE YÖNTEM: Çalýþmaya 2005–2018 yýllarý arasýnda üst ekstremitede yüksek basýnçlý enjeksiyon yaralanmasý olan 10 hasta alýndý. Tüm hastalar kompartman sendromu açýsýndan deðerlendirildi; varsa fasiyotomi ve geniþ debridman yapýldý. Ýlk debridmandan sonra ilk 24 saat içinde ikinci debridman yapýldý.
BULGULAR: On hasta (ort. yaþ 30) geriye dönük olarak deðerlendirildi. Enjekte edilen materyaller hayvan aþýsý, tiner, yað, dizel, su, plastik ve boya olarak bulundu. Ameliyat öncesi ve sonrasý ortalama WBC düzeyleri sýrasýyla 14.73 K/µL ve 9.62 K/µL idi. Ameliyat öncesi ve sonrasý ortalama nötrofil düzeyleri sýrasýyla 11.4 K/µL ve 6.49 K/µL idi.
TARTIÞMA: Erken ve seri debridmanlar ve kompartman sendromu deðerlendirmesi gereklidir. Tüm önlemlere raðmen amputasyon ile sonuçlanabilir. Malzeme, enjeksiyon kuvveti ve geçen süre prognozdaki ana belirleyicilerdir. Yüksek basýnçlý enjeksiyon yaralanmalarýnda agresif debridman gereklidir. Ancak, debridmanýn yeterliliði deðerlendirilmelidir çünkü dokuyu dizel veya tiner gibi materyallerden tamamen temizlemek imkansýzdýr. On olguluk çalýþmadan edindiðimiz tecrübeye göre klinik ve makroskobik olarak debridman yeterliliði gözlendiðinde eþzamanlý olarak WBC ve nötrofil seviyelerinin de düþtüðü belirlenmiþtir. Bu nedenle WBC ve nötrofil seviyeleri debridmanýn yeterliliði için bir indikatör olabilir, ne var ki bu yaralanmalar çok nadir yaralanmalar olsa da bu yorumu yapabilmek için daha geniþ çalýþmalara ihtiyaç vardýr.