Arch Hand Microsurg 2019; 24(3): 225-233  
Outcomes of Neglected Paint Gun Hand Injuries: Neglected Patients
Han Sol Shin1, Soo Min Cha2, Hyun Dae Shin2
1Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
2Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
Correspondence to: Hyun Dae Shin
Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 66 Munhaw-ro, Jung-gu, Daejeon 35015, Korea
TEL: +82-42-338-2480, FAX: +82-42-338-2481, E-mail: hyunsd@cnu.ac.kr, ORCID: https://orcid.org/0000-0003-4290-1125
Received: March 10, 2019; Revised: May 9, 2019; Accepted: May 29, 2019; Published online: September 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: We report a retrospective case series of patients who received delayed treatment for a paint gun hand injury.
Methods: From January 2001 to December 2016, 13 patients injured from the fingertip to the wrist and treated surgically after a 48-hour delay was evaluated. Basic demographic characteristics, injury mechanism, lesion, time-to-surgery, and degree of injury were investigated. The visual analogue scale (VAS) scores; Disabilities of the Arm, Shoulder, and Hand (DASH) scores; and Strickland evaluations were analyzed at least 2 years after injury.
Results: The surgery was performed at a mean 59.7 hours after injury. Soft tissue coverage was performed at a mean 8.2 days after the initial incision and debridement, and simple skin closure and full-thickness skin grafting were performed in 1 and 7 patients, respectively. Moreover, cross-finger flap, neurovascular island flap, retrograde island flap, and groin flap were used in one, one, one, and two patients, respectively. The mean follow-up period was 28.2 months, and the mean VAS and DASH scores were 0.92 and 36.3, respectively, whereas the outcomes of the Strickland evaluations were ‘good’ in two patients, ‘fair’ in seven patients, and ‘poor’ in four patients.
Conclusion: The recent mechanical development of paint guns has led to an increase in high-pressure injection injuries and resulted in greater accidental toxic paint injection into the fingers and hand. Thus, the toxic and inflammatory response progresses rapidly to acute compartment syndrome and necrosis, and delayed treatment is therefore associated with poor clinical outcomes.
Keywords: Paint, Gangrene, Flap


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