Closed Ring Avulsion Injury With Isolated Arterial Insufficiency

Area of Science:

• Orthopedics
• Vascular Surgery
• Trauma Surgery

Background:

• Ring avulsion injuries are uncommon but severe, often involving multiple tissue types.
• Reconstructive challenges arise due to potential damage to nerves, muscles, vasculature, and bone.
• Literature on isolated arterial injuries without soft tissue or bone involvement is scarce.

Observation:

• A patient presented with a cool, pale digit and abnormal pulse oximetry after a closed ring avulsion injury.
• Initial presentation lacked external wounds or fractures, necessitating further evaluation at a tertiary care center.
• Surgical exploration revealed isolated disruption of both digital arteries with intact digital nerves.

Findings:

• Successful revascularization of the digit was achieved.
• Treatment involved venous autografting and arterial thrombus stripping.
• This demonstrates a viable reconstructive option for specific ring avulsion patterns.

Implications:

• Highlights the importance of considering vascular injury in closed ring avulsions, even without external signs.
• Suggests that isolated arterial injuries are treatable, preserving digit viability.
• Informs surgical approaches for complex hand and digit trauma, emphasizing vascular reconstruction.