High-pressure water jet injuries: a surgical emergency

Injuries from high-pressure jet devices are surgical emergencies characterised by small entry wounds with extensive internal damage. Three factors are involved in these injuries. Physical injury can include local soft tissue disruption and vascular and nerve damage; chemical properties of the injectate can exacerbate compressive vascular injuries with increased oedema and inflammation; water-jet injuries can be contaminated by virulent organisms and foreign matter which can lead to unusual infections. Management is usually similar to that for injuries caused by high-velocity missiles, and involves aggressive debridement, irrigation and decompression followed by careful monitoring, and appropriate antibiotic therapy.