Chaitanya Mudgal, MD, Sharmila Mudgal, MD, and David
Ring, MD
Massachusetts General
Hospital and
Cambridge Hospital
Paint gun injuries are infrequent but severe injuries.
Resulting disability from inadequate or delayed management or both can be
severe and amputations can result. The aim of this paper is to present our
experience with early surgical management of these injuries. The contemporary
data as well as historical data are reviewed and presented. Our management
strategy is presented.
5 males sustained injuries to the non-dominant hand. 4
presented the same day. All underwent prompt irrigation, excision and
debridement. A Bruner incision was used in four patients. Paint was noted to
track along the neurovascular bundle in all and did not extend proximal to the
A3 pulley. No patient had paint within the flexor sheath. A sterile whirlpool
was used as part of the post-operative rehab in four patients. All patients
healed their wounds. Functional TAM was recovered in all patients.
Paint gun injuries almost always have a very innocuous
initial appearance. The entry wound is very small and initial pain is mild.
Non-dominant hand involvement is far commoner. The contents of the paint can
lead to severe manifestations. Water based paints and latex paints tend to be
much less toxic to the digital tissues, than do oil based paints. Tissues
within the digits have a high interstitial pressure, and injection of a viscous
substance at pressures of 5000 psi or greater into an unyielding digit leads to
severe increase in pressure. The paint tends to track along the neurovascular
bundle, and can cause necrosis of fat in the pulp and rest of the digit.
Paint contains 4 components; a binder, solvents, pigments
and additives. The composition of a particular paint type and the relative
content of solvents and additives which are toxic chemicals can influence the
severeity of tissue necrosis that can be caused, by that paint.
Early surgical debridenment is critical to a satisfactory
outcome. Every effort should be made to excise all the paint. Paint adherent to
skin may be left in situ. Wounds may be left open and a sterile whirlpool used.
Staged closure is another option. The severe nature of the injury must be
stressed to the patient at the very outset and the distinct possibility of
digital amputation should be discussed at the initial assessment.
Published by the New England Hand Society 2005.