Results of The Treatment of Four Ring Avulsion Injuries

Abstract

I report the treatment outcomes of four patients with ring avulsion injuries who required microsurgery. On the basis of the classification by Adani et al., one patient had class II, two patients had class III, and one patient had class IV injuries. The class II patient underwent venous repair and skin grafting with a venous flap, and the two class III patients and the class IV patient underwent replantation. One class III patient underwent the end-to-end anastomosis of an artery and a vein. Although the latter patient experienced postoperative venous thrombosis, the finger survived after a reoperation. The other class III patient underwent the anastomosis of two arteries and two veins with vein grafting and exhibited an uneventful postoperative course. The class IV patient underwent the anastomosis of two arteries with vein grafts and four veins with end-to-end anastomosis, and did not suffer any complicating postoperative vascular disorders. Ring avulsion injuries are a special type of degloving injury with a poor functional prognosis. Replantation is indicated for amputations distal to the insertion of the flexor digitorum superficialis ; however, its postoperative outcomes are not necessarily favorable. To improve the postoperative outcomes of such procedures, rehabilitation should be performed as soon as possible, and a precise microsurgical technique and primary wound healing are desirable in such cases.