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The Impact of Microsurgery on the Treatment of Ring Avulsion Injuries

Chiu, David T. W. M.D.; Matthew, Michael K. M.D.; Patel, Anup M.D., M.B.A.

Plastic and Reconstructive Surgery: December 2019 - Volume 144 - Issue 6 - p 1351-1357
doi: 10.1097/PRS.0000000000006276
Hand/Peripheral Nerve: Original Articles
Coding Perspective
Video Discussion

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.


New York, N.Y.; Lebanon, N.H.; and Orlando, Fla.

From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center; the Section of Plastic Surgery, Dartmouth-Hitchcock Medical Center; and the Orlando Plastic Surgery Institute.

Received for publication June 29, 2018; accepted March 19, 2019.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Related digital media are available in the full-text version of the article on

A Video Discussion by Kyle Chepla, M.D., accompanies this article. Go to and click on “Video Discussions” in the “Digital Media” tab to watch.

David T. W. Chiu, M.D., The Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 900 Park Avenue, New York, N.Y. 10021,, Twitter: @DRDAVIDCHIU, @dr_anuppatel, Instagram: @dr.anuppatel

Copyright © 2019 by the American Society of Plastic Surgeons