Ring avulsion: injury pattern, treatment, and outcome

Ring avulsion injury is classically believed to be one of the most challenging for the reconstructive surgeon. Injury patterns include a spectrum from laceration to complete amputation, with differential magnitude of injury to soft tissue, tendon, joint complex, and bone. Although ring avulsion injury can result in devastating functional and aesthetic loss to the hand, fear of even greater functional loss has made replantation a relative contraindication for this complex injury. This article hopes to clarify the pathomechanics and anatomy of ring avulsion, such that the elements of injury, which lead to poor survival and poor function, can be adequately addressed in the surgical plan.