Management History taking should include detailed information on occupational and recreational exposure. Prognostic factors in high-pressure injection injuries of the hand Type of fluid Paint, paint solvent, and paint thinner present highest risk of early tissue necrosis and gangrene. Grease, oil, and hydraulic fluid may cause no reaction during the first few days after injection. However, extensive fibrosis, oligogranuloma formation, and draining sinuses may occur thereafter. Amount of fluid injected Greater amounts of injected fluid are associated with increased vascular compression.
Higher pressures result in extension of fluid penetration.
Degree of spread of injected material Extent of spread depends on tissue partition. This is the most important prognostic factor. Highest risk for amputation occurs after 10 hours. Paint injections are among the most devastating injuries, and they require emergency surgical debridement because of extreme tissue toxicity. Injuries from clean water and air, depending on the severity of compression, can be managed conservatively.