Repair of ring avulsion injury can be challenging. Newer techniques in microsurgery and replantation have improved outcomes. However, poor outcomes will occur in complex cases.
General rules:
(1) outcomes are best for Urbaniak Grade 1 and worse for Grade 3
(2) preservation of the thumb is important for later function
(3) many avulsed fingers can be successfully replanted
Recommendations:
(1) shared decision making with the patient
(2) 2 or more veins should be patent
(3) an artery or vein in an adjacent finger can be transferred to the injured finger
(4) some form of nerve reconstruction should be attempted
(5) early mobilization and rehabilitation should be performed
Complications may include:
(1) congestion with swelling and skin compromise of the replanted finger
(2) infection
(3) loss of sensation and/or 2 point discrimination
(4) limited range of motion
(5) need for later amputation
(6) ischemia
(7) extensive scarring
