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Molten plastic injection injury of the hand: the burn injury from "within".

Penetrating molten plastic burns of the hand are unique because the burn occurs from “within.” During the operation of plastic injection molding machines, a jet of molten plastic penetrates the skin at high pressure. The molten plastic solidifies in the subcutaneous tissue, burning both the overlying skin and the underlying tendons. A 40-year-old man sustained a penetrating molten plastic injury. The fluid jet entered the dorsum of his left hand and solidified in the subcutaneous tissue, resulting in a third-degree burn of the overlying skin and necrosis of the underlying extensor tendons. Immediate debridement of the burnt skin and subcutaneous tissue was performed. The solidified plastic was removed. The burnt extensor tendons were not debrided and primary coverage was performed using a reverse radial forearm flap. By 2 months, recovery of full range of motion of all fingers was noted. Many years ago, penetrating molten plastic burns of the hand used to be a well-known industrial injury. The injury is no longer seen in industrial countries because of safety precautions. Our English literature review showed that the last report of the injury was in 1968. The 21st century features many developing countries in their early process of industrialization, which lack the proper safety precautions. Hence, this unique burn injury is likely to reappear again in the developing countries. Forty years ago, management of penetrating molten plastic injuries included debridement and dressing followed by skin grafts or groin flaps. This eventually resulted in hand salvage but hand function was significantly affected. Our patient underwent primary debridement and immediate flap coverage. The flap revascularized the burnt extensor tendons resulting in recovery of full function.