Replantation of ring avulsion amputations

Replantation of ring avulsion injuries is a challenge because of the long segment damage to the vessels and intrinsic damage caused to soft tissues at the proximal edge of the amputation. Eight patients with total ring avulsion amputations underwent microsurgical replantation in the period 1994 to 2002. Arterial repair was done by direct vessel suture in three patients, interposition vein grafts in two and cross anastomosis of the digital arteries in three patients. Venous anastomosis was carried out by mobilization and direct suture in seven patients and vessel transfer from the adjacent finger in one patient. Seven of the eight replantations were successful, while one patient had a partial failure. At a minimum follow-up of one year, these patients showed good functional and cosmetic recovery. All successful patients were happy with the outcome and none have requested for amputation, even those whose results were not functionally adequate. However, in addition to technical factors, it is important to evaluate the patient's motivation to undergo not only the long surgery, but also multiple secondary procedures and regular supervised physiotherapy. We also describe a simple method which prevents the soft tissues inside the degloved digit from becoming wrapped around the K wire during bony fixation, thus making one step of this technically challenging procedure a little easier.