We have seen patients who were injured when the ring was caught in a moving vehicle, while the person wearing the ring was alighting. At workplace, the injury occurs when a ring worn by a person gets caught in the moving part of a machine. Ring avulsion amputation is a rare injury. Silicon prosthesis was to be made to order if the patient found the prosthesis useful. After a month, the patient was given a locally manufactured inexpensive prosthesis made of polyvinylchloride on a trial basis. The healing was primary and the recovery was uneventful. The flaps were divided and set in after 3 weeks. ![]() The secondary defect was covered with a split skin graft from the thigh. The de-epithelialised flap from the little finger was used to cover the dorsal aspect of the ring finger. The flap from the middle finger provided cover for the volar aspect and the tip of the ring finger. It was decided to salvage the degloved middle phalanx using a cross finger flap each from the two adjoining fingers. The flexor digitorum profundus was pulled out (as reported by the patient). The flexor digitorum sublimis was intact and uninjured. On examination, there was a total loss of the terminal phalanx and degloving of the middle phalanx. One of the patients returned to the hospital for some other reason in 2012 and provided us with an opportunity to see a 25 year follow-up of this technique. These cases were presented at the annual conference of the association of plastic surgeons of India at Baroda in 1988 as ‘the sandwich technique’. The author has performed a similar procedure in three patients in 1987, but was not able to follow these patients and hence could not publish his results. In 2010 Abo-hashem Azab Moosa reported the use of double cross finger flaps to cover the stump of the injured finger in a series of 22 cases with good results followed-up for a mean period of 6 months. The use of de-epithelialised flaps has been described for various applications including hand and finger injuries. There has also been a preference for a revision amputation due to poor results of attempts at reconstruction. ![]() These include split skin grafts, full thickness skin grafts, cross finger flaps, fillet flaps, local flaps from the hand and groin and abdominal flaps. Many grafts and local and distant flaps have been reported to cover the stump after avulsion of the ring finger in various combinations. However, there is a group of patients where either the avulsed part is missing or mutilated and unsuitable for revascularisation. A number of additional procedures such as venous flaps and arterialised venous flaps have been reported by various authors. Current trend is to replant the avulsed tissue in spite of a high rate of failure. Kay's classification takes into account the presence of skeletal injury. These injuries have been classified into three types based on circulatory status. Occasionally, the tendons may be avulsed. A forceful pull on a ring worn by a person can lead to a wide variety of injuries from a simple contusion to total degloving and amputation. Avulsion amputation of the fingers is fortunately rare.
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