Pitfalls

• The appearance of the wound does not determine the severity of the injury.

• Amputation is more likely if debridement is delayed more than 10 hours, especially with low viscosity substances.

• Without diagnosis and treatment, a compartment syndrome with subsequent necrosis usually destroys tissue viability.

• Do not use small openings for debridement.

Physical Examination

The paint stream struck the palm with such pressure that the liquid penetrated the skin and spread widely throughout the underlying fascial planes and tendon sheaths. To assess the severity of the injury, the type of injected material and the time of the injection were determined. Circulation surrounding the injury was assessed by observing the general skin color and temperature and capillary refill. To confirm dual circulation to hands and fingers, the Allen's test was performed (Fig. 3—1). Anterior forearm compartment was evaluated by passive wrist and finger extension. Distention of the tissue and the resulting inflammatory reaction caused

Digital Allen Test

Figure 3-1. (A—D) Demonstration of digital Allen's test to confirm circulation offingers.

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