Unique superiority of microsurgical repair technique with its functional and aesthetic outcomes in ring avulsion injuries

Abstract

Although ring avulsion injuries are not common, when they do occur their management is still a challenging problem in reconstructive surgery. In this report, we present our microsurgical experiences with Kay's class III and IV ring avulsion injuries. A total of six patients with ring avulsion injuries were operated on between 2000 and 2004. Three patients were in class III with inadequacy of both arterial and venous circulation, and the remaining three were in class IV. The study consisted of four male and two female patients whose ages ranged from 23 to 43 (mean age 32). Average ischaemic time was 2.2 h (range 1-4 h). The ring finger was involved in all cases and microsurgical repair was performed using axillary block anaesthesia. The bone was detached at the level of the distal interphalangeal joint and soft tissues at the proximal phalanx level with the preserved proximal interphalangeal joint and flexor digitorum superficialis tendon in all cases. Because the zone of injury is more extensive, we debrided the avulsed digital artery over a long distance, and used long interpositional vein grafts radically in all patients. Venous drainage was accomplished by performing at least two vein anastomoses using vein grafts when necessary. Both digital nerves were repaired primarily after debridement. Results indicated that microsurgical repair had a success rate of 100%. The authors conclude that microsurgical reconstruction of ring avulsion injuries with intact proximal interphalangeal joint and flexor digitorum superficialis tendon yields superior results, both functionally and aesthetically, even in complete amputation.