Analysis of prognostic factors in ring avulsion injuries

Digital Avulsion With Compromised Vascularization

“…The first feature that stands out is with regard to the number of arteries reconstructed: 2 arteries in 2 cases and only 1 in 14 cases, whereas the policy in our department is to reconstruct 2 arteries if possible as recommended in the literature. 1,17,21,[27][28][29] This could be done in 2 patients, only 1 artery was reconstructed in the remaining 14 patients. This limitation of 1 artery attested to the extent of the vascular lesions and the poor conditions for the attempted revascularization.…”

“…In light of those findings and clinical results, many investigators have recommended the use of venous grafts. 3,35 Nevertheless, in a series of 86 digital amputations by avulsion in adults, Sanmartin et al 27 concluded that the rate of survival was higher when primary end-to-end apposition could be achieved than when a venous graft was necessary, and attributed this to the fact that the lesions were less extensive in the former case. In our series, a venous graft was achieved in 6 of the 16 cases of revascularization.…”

“…Second, the number of veins repaired has been reported as a prognostic factor, with significant improvement in the survival rate after the reconstruction of more than 1 vein, even if a venous graft is necessary. 10,27,36 Nevertheless, Chaivanichsiri and Rattanasrithong 36 concluded that vein reconstruction was necessary except when the level of amputation was at the distal phalanx, in which case searching for a vein in the injured tissue added to the lesions increasing the risk of replantation failure. We agreed that vein repair is required to increase survival rate, that is, the impossibility repairing the vein decreases the prognosis.…”

Salvage of Complete Degloved Digits With Reversed Vascularized Pedicled Forearm Flap: A New Technique

“…25 An alternative method to vein grafting is to transfer an artery or vein from the middle finger. This method is well known in thumb replantation and has been reported in the management of ring avulsion injuries as well.…”

Alternative à la replantation dans les amputations type doigt d’alliance stade IV : amputation basimétacarpienne d’emblée

“…Les taux de succès dans la littérature sont très variables (37,5 % pour Foucher et al [1] ; 85,7 % pour Adani et al [2,3]). Les interventions secondaires sont également fréquentes dans ce type de traumatisme [4]. Nous proposons désormais, dans les cas d'amputation complète par bague de l'annulaire, une régularisation d'emblée en base de métacarpien.…”