Soft Tissue Restoration with Reverse Forearm Flap in a Patient of Extensive High Pressure Injection Injury to the Hand

Abstract

Background: High pressure injection injury to the hand can result in severe soft tissue damage, despite the often benign appearance at the initial presentation. The true extent of the injury is often masked by a small and harmless puncture on the finger or palm. The severity of the injury depends on the force of the injection, the type and the amount of the material injected. From literature reviewed, no amputation rate was noted in cases with water-based paint injections, while an amputation rate of 50% was noted in cases with oil-based paints. Aim and Objectives: We report the surgical management of high pressure injection injury to the hand with areverse forearm flap reconstruction. Materials and Methods: We report a case of high pressure injection injury to the left index finger by oil-based paint. Reverse forearm flap was performed to reconstruct the index finger. Results: Finger ray amputation was avoided by aggressive soft tissue debridement and reconstruction with a reverse radial forearm flap. Fair hand function was restored and the patient could return to work early. Conclusion: Our case demonstrated that an extensive high pressure injection injury to the hand could be salvaged by aggressive soft tissue debridement and a custom-designed reverse radial forearm flap. Severe morbidities such as ray amputation of finger could be avoided.