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Objectives: Poorly standardized, the management of high pressure injections (HPI) is frequently too late and inadequate, some teams reporting up to 50% of amputations. HPI causes inoculation of toxic particles in depth, particularly difficult to remove surgically. The persistence of this foreign material maintains local inflammation and increases the risk of infection. The objective of this article is to validate the benefit of a systematic "second look" at 48-72 hours in HPI., Methods: We conducted a retrospective study from 2006 to 2010, of patients who had a HPI into the hand. All patients had initial debridement surgery and a "second look" was systematically performed at 48-72 hours., Results: During this period, six patients were treated for a HPI of paint (n=4) or oil (n=2). The time between the accident and surgery was 12.4 hours (2-24). Four patients had good functional outcome with no disabling sequelae. We performed two amputations. At six months, five patients returned to work., Conclusions: Early management determines the prognosis of the HPI. Extended debridement within six hours showed a better functional outcome than later treatment. Performing a systematic "second look" allows further washing/debridement and gives the possibility to be more conservative during the initial procedure. This second debridement allows excision of the newly formed necrosis and to evacuate the remaining toxic residues. Finally, patients reported good functional outcome., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

A 69-year-old woman presented with a tumor of the lateral aspect of the proximal phalanx of the little finger of the right hand. The finger was injured by a ring during a handshake. Excision and histopathological examination revealed the diagnosis of angio-myoma, a benign vascular tumor originating from the smooth muscle cells of arterial or venous walls. Angiomyomas belong to the family of leiomyomas and rare, small tumors (less than one centimeter), preferentially occurring in women between the ages of 40 and 60 years. They may be painful. Only one case of sarcomatous degeneration has been described in the literature. Trauma has never been previously reported as a cause of angio-myoma, but in this case the traumatic origin of the tumor was not in doubt.