The impact of microsurgery on the treatment of ring avulsion injuries
Retrospective review published in Plast Reconstr Surg (2019)
Abstract
BACKGROUND: Treating ring avulsion injuries continues to challenge the reconstructive hand surgeon. The complex operation draws from plastic surgery and orthopedic surgery principles to provide soft-tissue coverage, skeletal fixation, tendon repair, and neurovascular reconstruction. Furthermore, the application of microsurgical techniques has enabled the revascularization and replantation of completely avulsed fingers. METHODS: A retrospective review of 22 consecutive ring avulsion injuries (seven amputations, five replantations, and 10 revascularizations) from 1987 to 2015 performed by a single senior surgeon (D.T.W.C.) was conducted. RESULTS: Of these 22 ring avulsions, 10 revascularizations, five replantations, and seven amputations (five because of clinical factors, and two because of patient request) were performed. None of the 15 replantations and revascularizations resulted in loss of the ring finger or necrosis of the revascularized tip. CONCLUSIONS: With proper patient selection, appropriate level of injury identification, and meticulous surgical execution, the restoration of form and function to the hand is feasible in ring avulsion injuries. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Single-surgeon 28-year retrospective review of 22 ring-avulsion injuries showing 100% replant/revascularization success in 15 attempted cases.
Why This Matters for Hirudotherapy
This single-surgeon retrospective review of 22 consecutive ring avulsion injuries (seven amputations, five replantations, ten revascularizations) reports that none of the 15 replanted or revascularized digits were lost or developed tip necrosis, concluding that with careful patient selection and meticulous microsurgical technique, restoration of form and function is feasible. The relevance to hirudotherapy is contextual rather than direct: replantation and revascularization of avulsed digits are precisely the high-stakes settings in which venous congestion can threaten flap and digit survival, and medicinal-leech therapy is an established adjunct for relieving such congestion when venous outflow is inadequate. As a single-center retrospective case series rated Level IV evidence, it documents what microsurgical salvage can achieve but does not itself study or test leech therapy, so it should be cited only to frame the clinical landscape, not as evidence for leeching.
Citation
The impact of microsurgery on the treatment of ring avulsion injuries.
Chiu DT et al. · Plastic and reconstructive surgery, 2019
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