Management of high-pressure injection injuries

High pressure injection injuries are defined as puncturing of the dermis by a jet of fluid or air under pressure. When a leak or accidental activation occurs, a pressure of only 100 pounds per square inch (psi) is enough to puncture human dermis. Whilst uncommon, a hand centre in the United Kingdom (UK) is expected to see one to four cases presented per year1. If untreated or inadequately treated, the consequences of these injuries are devastating. In this article we provide an overview for clinicians to understand why high-pressure injuries are so damaging and under-recognised. We then provide an outline of how these limb threatening injuries should be managed as surgical emergencies.