Ring Avulsion Injuries Research Articles

Ring avulsion injuries: Classification and prognosis

Fifty-five cases of ring avulsion injury were reviewed to examine how extent of injury and surgical management correlated with results. After injury, three patients had adequate circulation. Of 52 patients with inadequate circulation, 8 had primary amputation; salvage was attempted in 44. Of these 44, 9 fingers were amputated secondarily, 19 were successfully revascularized, and 16 were successfully replanted. Return-to-work time averaged between 4.5 and 10.3 weeks. Cold symptoms occurred in 65% of salvaged fingers. Range of motion was usually normal at the metacarpophalangeal joint; most patients had 90 degrees or better combined arc of motion at the proximal and distal interphalangeal joints. Two-point discrimination of less than 10 mm returned in 47% of patients with injured nerves. Most patients whose fingers were successfully salvaged were glad they had had the procedure. We conclude that amputated digits are salvageable and propose a classification system that includes skeletal injury.

Results of treatment of 48 ring avulsion injuries.

A retrospective study of 48 patients with ring avulsion injuries was performed. Patients were grouped according to severity of damage. Revascularization with interposition grafts was performed in all patients where indicated. In contrast to the experience of others, even class III lesions (total avulsion) were salvaged.

Results of Treatment of 48 Ring Avulsion Injuries

Results of Treatment of 48 Ring Avulsion Injuries

Clinical Study of Ring Avulsion Injuries

Between 1977 and 1986, nine patients with an isolated ring avulsion injury were seen in the Orthopaedic Surgery Division of Hiroshima University School of Medicine. Eight fingers were reconstructed by use of microsurgical anastmosis. Five have been successfully revascularized, and useful motion and sense of the digits have been obtained. Three were treated by secondary amputation due to the necrosis of the digits and one by primary amputation.Micosurgical revascularization has been particularly useful in salvaging incomplete ring avulsion injuries with insufficient vascular flow. Although complete ring avulsion injuries in general are thought to be poor candidates for microsurgical repair, these should be treated by replantation, in which it would be often necessary to shorten bone or use vein grafts.

Ring Avulsion Injuries, Care of Amputated Parts, Replants, and Revascularization

Microsurgery has improved our ability to deal with severe injuries to the upper extremity. Good medical management and judgment plus a sense of realism communicated from physician to patient is as important as the surgical technique.

Class IIA ring avulsion injuries: An absolute indication for microvascular repair

The class II ring avulsion category, includes those patients in whom only digital arteries are damaged but all other structures are intact and functional (here labeled class IIA). Current literature suggests this is a rare lesion. Seven patients with this specific injury in whom the affected digits were nonviable are reported. Four of the seven were misdiagnosed on initial emergency room evaluation. Two did not seek additional medical attention and the condition progressed to necrosis and amputation. The other two, who sought additional treatment because of progressive ischemia, and three additional patients who were correctly diagnosed on initial examination underwent simple digital arterial repair. All digits operated on survived and demonstrated near normal function. Since failure to operate results in digital loss, this is an absolute indication for microvascular repair.

Primary microsurgical repair of ring avulsion amputation injuries

Patients with ring avulsion injuries of the fourth and fifth digits often demand attempts at reconstruction rather than completion of the amputation. In the past, this has led to reconstruction involving a staged series of operations with results that were often less than desirable. Seven patients with ring avulsion amputation injuries that were reconstructed by use of microsurgical reanastomoses are reported. All were classified as either Carroll type IV or Urbaniak type III. Six patients (85%) had a successful replantation leading to a useful finger. The operating time averaged 5.5 hours. On average, 1.9 arteries (range 1 to 2) and 3.3 veins (range 2 to 5) were repaired for each digit. Average hospital stay was 6.7 days (range 4 to 15). Average range of motion was 0(2)/84(2) for metacarpophalangeal joint and 15(2)/90(2) for proximal interphalangeal joint (PIP) with distal interphalangeal joint ankylosis at between 0(2) and 15(2) of flexion. Sensibility was protective in all cases and good in three. If the PIP joint was damaged, completion of amputation was the treatment of choice. If the amputation is distal to the PIP with a functional superficialis tendon, primary microsurgical repair is the treatment of choice in complex ring avulsion injuries.

Microvascular management of ring avulsion injuries

Microvascular management of ring avulsion injuries

Microvascular management of ring avulsion injuries

Microsurgical revascularization has proved to be a useful method in managing the ring avulsion injury where both neurovascular bundles are damaged with only partial skin avulsion. Representative cases are used to illustrate guidelines for a practical classification for helping to decide the optimal method of treatment of acute ring avulsion injuries in light of digital revascularization techniques. Nine ring fingers were successfully revascularized of 24 acute ring avulsion injuries reviewed. Sensibility recovery was good and a functional range of motion obtained. No patient who has had his ring finger revascularized has requested its amputation because of appearance, painful neuromas, stiffness, or cold intolerance. Complete amputations, especially proximal to the superficialis insertion, and complete degloving injuries of the ring finger are usually best managed by surgical amputation of the digit.