Optimal Irrigant in High Pressure Paint Injection Injuries of The Hand
Corey M Bascone, MD 1 ; Benjamin Sheber, MD 2 ; Dattesh Dave, MD 1; Joseph M Firriolo, MD 1; Clifford Pereira, MD, 1 1 Division of Plastic and Reconstructive Surgery, University of California Davis, Sacramento, CA, USA 2 Department of Surgery, St. Agnes Hospital, Baltimore, MD, USA
Background: 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 & flat white oil-based paint, respectively. Each digit received a longitudinal incision and was scrubbed for 120 sec. 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 2 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 through 5) (i.e. 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, & Techni-care were ranked as top 3. All reviewers reported detergents better than saline alone.
Conclusion: 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.
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