High-Pressure Injection Injuries to the Face: An Unusual Case, Review of the Literature, and Proposed Management Algorithm.

High-pressure injection injuries to the hand are well-described, but similar injuries to the face are far less common and sporadically reported. Due to the complexity of facial anatomy and benign initial clinical presentation, these injuries can be underappreciated, leading to a delay in treatment and undesirable outcomes. In this paper, the authors present an unusual case of a pressurized diesel fuel injection injury to the face via an entry wound at the base of the nare. The caustic fuel caused widespread liquefactive necrosis of the subcutaneous fat of the face, orbit, and neck, requiring serial operative debridements by plastic surgery, oculoplastic surgery, and otolaryngology, respectively. Following a 20-day hospital course and seven total operations, the patient was discharged home with an infraorbital wound resulting in ectropion, requiring ectropion release and repair and full-thickness skin grafting. When managing injection injuries to the face, it is important to determine the exact mechanism of injury and appreciate the severity of underlying soft tissue damage that can progress quickly with delayed intervention. In most cases, early operative intervention is required, as well as early multidisciplinary care involving intensivists and ophthalmology, to optimize outcomes.