Optimal Irrigant in High Pressure Paint Injection Injuries of the Hand

High pressure injection injury to the hand with paint leads to amputation rates near 48%. Historically, authors utilized saline irrigation alone, but have high reoperation rates. We conducted a cadaveric study to determine the ideal detergent for effective paint removal from the soft tissue.

Two cadaveric hands were amputated from the same cadaver. The left and right hand digits were injected with flat white latex-based paint and flat white oil-based paint, respectively. Each digit received a longitudinal incision and was scrubbed for 120 seconds 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 two 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) (ie, 1 = most paint-free soft tissue).

The two hand faculty had an inter-rater reliability of 0.70. Both reviewers ranked povidone-iodine 10% or Johnson & Johnson shampoo as the best irrigant for latex-based paint. In oil-based paint, povidone-iodine 10%, Johnson & Johnson, & Techni-care were ranked as top three. All reviewers reported detergents were better than saline alone.

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 high-pressure injection injury should consider using Povidone-Iodine 10% or Johnson & Johnson baby shampoo for latex- or oil-based paint.