High-compression injection injuries to the hand.

The importance of a specific effect of various agents injected into the hand cannot be overemphasized, since the outpouring of inflammatory edema fluid as a response to the more sclerotic solutions leads to tamponade and occlusion of digital vessels. Moreover, it has been shown that the vascular insufficiency is further increased by actual necrosis of small vessel walls caused by these solutions, which coagulate the protein of the arteriolar and arterial wall. The pathologic physiology is described, which indicates that the usual case of high-compression injection of foreign material into the hand develops severe and sometimes catastrophic consequences related to the tamponade effect occurring from the compression force, the quantity of material injected, and the subsequent outpouring of inflammatory edema fluid occasioned by the chemical irritation of these substances within the tissues. Based upon these findings, it has been pointed out that early treatment of these injuries is mandatory, with adequate incision along diagonal lines on the palmar surface of the hand made with the idea of decompressing the tamponade effect on the digital vessels as well as evacuation of the foreign material. Careful cleansing of the surrounding tissues to remove extensions of the material from the central mass is important. Finally, the postoperative measures, the late treatment procedures, and the rehabilitative surgical procedures have been described.