MANUAL MINORS
Ring avulsion is a severe injury in which a ring gets caught on an object, causing traumatic damage to the finger by partially or completely stripping away the skin, underlying tissues, tendons, nerves, and potentially damaging blood vessels and bone.
This type of injury can range from superficial damage to complete amputation of the finger, depending on the force and mechanism of the trauma. Ring avulsions are surgical emergencies, as they can severely compromise the viability of the finger.
Diagnosis
Diagnosis is based on the patient’s clinical history (usually involving a ring entrapment injury) and physical examination. Injuries can range from degloving, where the skin and underlying tissues are stripped away, to deeper injuries with loss of vascular and nerve function.
It is essential to assess the finger’s circulation (presence or absence of pulse, pallor, coldness), mobility, and nerve integrity. Imaging studies such as X-rays are often used to assess bone condition and rule out fractures.
The Urbaniak classification system is often used to determine the severity of the injury:
Grade I: Injuries with good blood flow, without significant vascular damage.
Grade II: Injury with significant vascular damage, but without complete amputation.
Grade III: Complete amputation of the finger.
Emergency Management
In initial management, controlling bleeding is critical. In severe cases, a tourniquet may be required but should be used cautiously to avoid additional damage. The finger should be carefully cleaned with sterile saline solution, and a moist sterile dressing applied to protect exposed tissues.
Administering analgesics and antibiotic prophylaxis is essential, along with ensuring tetanus vaccination is up to date. The finger should be immobilised, and unnecessary manipulation should be avoided until a specialist surgeon can assess the injury.
Prompt referral for surgery is crucial, especially if there is vascular, tendon, or nerve involvement.
In cases of partial or complete amputation, it is vital to preserve the amputated finger properly (wrapped in moistened sterile gauze and placed in a bag on ice) if reimplantation is considered.
Definitive Treatment
Definitive treatment depends on the severity of the injury. In cases of partial avulsion, reconstructive surgery of soft tissues, tendon repair, and restoration of circulation may be possible.
For more severe injuries that compromise the viability of the finger, microsurgical reimplantation may be necessary if conditions permit. In other cases, where reimplantation is not feasible, surgical closure of the stump is performed to ensure proper healing and maximum preservation of function.
Post-surgical rehabilitation is crucial, with physiotherapy to regain mobility and function of the affected finger, although full functionality may not be recoverable in severe cases.
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