Complete ring finger avulsion: Review of 16 years of cases at a Hand Emergency Unit

Replanting complete ring avulsion injuries remains a challenge for hand surgeons. The prognosis depends on achieving satisfactory function. We present the results of our 16 years' experience with managing this type of injury. Our cohort consisted of 83 cases of complete ring avulsion injuries in patients with an average age of 23.5 years, treated in a Hand Emergency Unit between 1998 and 2014. Seventy-two were replanted. A vein graft was used in 57 cases to bridge the arterial injury and direct anastomosis was performed in 15 cases. Forty-one cases were a microsurgical success. Twenty-four patients were reviewed with an average follow-up of 87 months. The mean of total active motion was 164°, with 64° range of motion in the proximal interphalangeal joint on average. The two-point discrimination for sensitivity averaged 6mm. Two cases of severe cold intolerance were noted. Using a graft for vascular repair increases the odds of microsurgical success. The functional outcome depends on the condition of the proximal interphalangeal joint. Cold intolerance and lack of sensitivity have little effect on the functional outcome and patient satisfaction. Replantation of complete digital avulsion injuries should be attempted. Amputation at the metacarpal base is better discussed later on, after the initial surgery.