High-Pressure Paint Gun Injury of the Thumb: A Case of Reconstruction Using a Reverse Thenar Perforator-Based Island Flap

Abstract

Hand injuries due to high-pressure paint gun devices are rare but may lead to serious outcomes. The authors describe a case of a high-pressure injury of the thumb that was managed promptly and later reconstructed successfully with minimal functional deficit. A 39-year-old man with a high-pressure paint gun injury of the right thumb was referred. Though the external wound was small, X-ray and computed tomography images showed extensive spread of paint inside. The paint was removed through a wide skin incision. After 6 weeks, the surgical wound had completely healed, except for a defect around the interphalangeal joint with bone exposure. A reverse thenar perforator-based island flap based on the princeps pollicis artery was elevated and moved to the defect. After defect reconstruction, the patient recovered pinch and grasp function through physiotherapy. High-pressure paint gun injuries of the thumb can lead to significant functional deficits of the hand. A small skin lesion may cause the actual extent of damage to be underestimated, as extensive penetration of paint can cause severe damage to the soft tissues. Thus, immediate surgical removal of the paint and coverage of the remnant wounds with an appropriate flap are necessary.