High-pressure injection injury of the finger
A 57 year-old man presented with a painful, swollen, and discolored left index finger. The patient had sustained a high-pressure injection injury by lubricant injector (pressure being around 5000 psi) a week ago. There was a small puncture wound just proximal to the distal interphalangeal (DIP) joint crease with surrounding induration along with loss of sensations and compromised vascularity of the volar skin, distal to the proximal interphalangeal [PIP] joint crease []. The capillary refill was found to be sluggish and the oxygen saturation [SpO2] probe showed no signals. The X-ray of the finger was suggestive of soft-tissue swelling with no radio opacities. The patient was aggressively managed in stages. First, the wound was explored with Brunner's zig-zag incision with immediate decompression and debridement of necrotic tissue and foreign material. The wound was left open and dressed. After 2 days, a second look was given and further debridement of the non-viable volar tissue was done []. The resultant volar defect with exposed tendons on the left index finger was covered by a superior based abdominal flap []. The flap was delayed after 3 weeks, with final insetting after 6 days, with satisfactory result []. At 3 months follow-up, the flexion at DIP and PIP joints was satisfactory allowing the patient to return to his pre injury occupation [].