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Handchir Mikrochir Plast Chir 2001; 33(5): 332-341
DOI: 10.1055/s-2001-17765
Originalarbeit

Georg Thieme Verlag Stuttgart · New York

Hochdruck-Einspritzverletzungen der Hand - Pathogenese, Probleme und Therapie

High-Pressure Injection Injuries of the Hand. Pathogenesis, Problems and TherapyG. Rappold, Elisabeth Rosenmayr
  • Unfallkrankenhaus Lorenz Böhler; Wien XX, (Ärztlicher Leiter: Prim. Prof. Dr. H. Hertz)
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Publication History

Publication Date:
12 October 2001 (online)

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Zusammenfassung

Die Schwere dieser Handverletzung wird oftmals unterschätzt und führt in sehr vielen Fällen zu bleibenden Schäden, vor allem aber zu Funktionseinbußen der Hand. Art, Druck, Volumen und Gewebstoxizität der injizierten Substanz bestimmen den Verlauf und letztendlich auch das Ergebnis. Das Hauptproblem dieser Verletzung ist das toxische Ödem mit der Gefahr der Ischämie und Entwicklung einer Gangrän, die zu einer Amputation zwingen kann. Pathophysiologisch bestehen mehrere oft synchrone Angriffspunkte; neben einem Tamponade-Effekt durch Druckerhöhung spielen Mikrothrombosen, Gefäßspasmen und ein inflammatorisches Geschehen eine wesentliche Rolle, abgesehen von den Irritationen chemischer Genese. Im zeitlichen Ablauf lassen sich fast immer drei Stadien beobachten. Rasches Handeln, verbunden mit einer ausgedehnten Dekompression und radikalen Ausräumung sämtlichen Fremdmaterials sowie nekrotischen Gewebes, verbessert die Prognose entscheidend. Einer primär offenen Wundbehandlung mit geplanten Second-look-Eingriffen und wiederholtem, sorgfältigem Débridement schließt sich in der Sekundärphase der sichere Wundverschluss, vorzugsweise mittels Lappenplastiken, an. Rekonstruktive Eingriffe bleiben der Spätphase vorbehalten.

Von 43 Patienten des eigenen Krankengutes der vergangenen 28 Jahre (1972 bis 2000) heilten nur neun Patienten folgenlos aus; bei 12 Patienten (28 %) war eine Amputation in unterschiedlichem Niveau erforderlich. Schmieröl und Farbe oder Farblösungsmittel waren die am häufigsten injizierten Substanzen.

Summary

High-pressure injection injuries are rare and the extent of tissue damage is often underestimated. They usually have devastating effects on tissues and result in poor functional outcome of the involved hand. The severity of these injuries is related to the nature, pressure, volume and toxicity of the injected substance. The major problem of this injury is a toxic edema followed by ischemia, causing a gangrene of the involved finger, which may require amputation. The pathogenesis is characterized by different, but often synchronous onsets, leading to an apparent chain of events that occur once the material has been injected. Increase of pressure within the closed space leads to tamponade, intravascular thrombosis and spasm of vessels create circulatory embarrassment, a chemical irritation provokes an acute inflammation. Three stages of progress are described. Timing is an important factor influencing the results. An early, wide decompression and aggressive debridement with complete removal of foreign substances and necrosectomy is recommended in the acute stage and will improve prognosis and outcome. Open wound treatment and second-look operations during the intermediate stage are followed by secondary wound closure with local or free flaps, if necessary. We emphasize the role of early active motion during this time. Reconstructive surgery is reserved for the late stage.

43 patients were treated surgically in our department over the last 28 years (1972 to 2000). 12 of them (28 %) required amputation at different levels of the involved finger. Only nine patients healed without any functional loss. Most frequent injuries were of the paint or paint-solvent and grease-gun type.

Schlüsselwörter

Hochdruck-Einspritzverletzungen - Finger - Hand

Key words

High-pressure injection injury (HPII) - hand - finger

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1 vormals: 200 bis 1200 at; 1 at = 1 kp/cm² (0,981 bar) = 100 000 Pa; 1 MPa = 1 000 000 Pa.

Dr. med. Georg Rappold

Unfallkrankenhaus Lorenz Böhler

Donaueschingenstraße 13

1200 Wien

Österreich

Email: georg.rappold@auva.sozvers.at

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