Optimal Irrigant in High Pressure Paint Injection Injuries of the Hand

Abstract

INTRODUCTION: High-pressure injection injury (HPII) to the hand with paint leads to amputation rates near 48%. Historically, authors utilized saline irrigation alone, but have high re-operation rates. We conducted a cadaveric study to determine the ideal detergent for effective paint removal from the soft tissue. METHODS: Two cadaveric hands were amputated from the same cadaver. The left and right hand digits were injected with flat white latex-based paint and flat white oil-based paint, respectively. Each digit received a longitudinal incision and was scrubbed for 120 seconds with 50 mL of a randomly assigned detergent and no detergent (saline) as the control. After achieving a lather, each finger was cleansed with 50 mL saline before being evaluated by two blinded hand surgery faculty. Reviewers assessed the washouts as adequate or inadequate, in order to generate a Kappa statistic and measure inter-rater reliability prior to ranking each digit (1–5) (ie, 1 = most paint-free soft tissue). RESULTS: The two hand faculty had an inter-rater reliability of 0.70. Both reviewers ranked Povidone-Iodine 10% or Johnson & Johnson baby shampoo as the best irrigant for latex-based paint. In oil-based paint, Povidone-Iodine 10%, Johnson & Johnson, and Techni-care were ranked as top three. All reviewers reported detergents better than saline alone. CONCLUSIONS: The addition of detergent created an irrigant that removed both latex and oil-based paint better than normal saline alone. Based on these results, surgeons treating HPII should consider using Povidone-Iodine 10% or Johnson & Johnson baby shampoo for latex or oil-based paint.