Microsurgical treatment of ring avulsion injuries

Fourteen patients with ring avulsion injuries were treated at the University of Ioannina from 1982 to 1991. One patient was classified as Urbaniak class II, and microsurgical repair produced good functional results. The remaining 13 patients had class III injuries. Six of these patients had class IIIa injuries, defined as skin avulsions at the level of the proximal phalanx, amputation at the distal interphalangeal joint with an intact flexor digitorum superficialis. Replantation was successful in four patients. Seven patients had class IIIb injuries, defined as skin avulsion and complete amputation at the level of the proximal phalanx, with severance of both flexor tendons. Replantation was successful in four patients, with compromised functional results in two. Primary surgical repair is the treatment of choice for class II and IIIa injuries which usually have rewarding results. Although there may be some functional compromise following replantation in class IIIb injuries in adults, we suggest that microsurgical replantation should also be attempted after the prognosis is clearly explained to the patient.