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Ring
avulsion injuries
Patients
may catch their wedding band or other finger ring on moving machinery or
on a protrusion from a surface as they jump or move away from it. The sudden
pull on the ring may result in a small wound, a circumferential wound,
or an amputation. These injuries have been classified most recently (Kay)
as follows:
-
I Circulation
adequate
-
II Circulation
Inadequate
-
IIA Digital
arteries injured only
-
IIB Digital
arteries + skeletal injury
-
IIC Digital
veins injured only
-
III Complete
amputation
With this
mechanism, the actual extent of injury is always much greater than what
it appears. High-speed photography of the injury in a cadaver model has
shown that relatively little force is required to momentarily turn the
entire soft tissue envelope of the finger inside out. Because the external
wound may be small and motion maintained through the intact flexor and
extensor tendons, the extent of injury may not be appreciated initially
and the patient may be discharged, only develop signs of progressive ischemia.
Arterial thrombosis along the length of the finger may prevent successful
revascularization even with grafts and the possibility of a proximal or
even ray amputation should be discussed with the patient at the time of
initial evaluation.
 Ring
Avulsion Injuries
 |
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