High pressure injection injuries of the hand. A clinical, chemical and histological study

Although high pressure injection injuries of the hand are frequently described, little is known about the mechanism of tissue necrosis. A case is described which led to digital amputation and the clinical features are discussed in relation to others reported. The digit was examined histologically and a sample of liquid drained from the palm was subjected to organic chemical analysis. The findings of widespread vessel thrombosis, absence of fat from fat loculi, and coagulative necrosis of skin and subcutaneous tissue becoming less marked the more proximal in the digit suggest a chemical inflammatory cause. This is supported by chemical analysis revealing a fat solvent as the chemical agent and fat degradation products in the palmar liquid.