ABSTRACT
TIP: Occupation should be considered in the decision-making process. Many laborers prefer revision amputations at this level to allow quick return to work with adequate functional results.
RING AVULSION INJURIES n Ring finger classifications6
• Type I: Soft tissue injury without vascular compromise Treatment: Standard neurovascular approach
• Type II: Soft tissue damage with arterial and/or venous compromise Treatment: May require coverage of vascular repairs using local flap or flow-through venous
flap harvested as skin and soft tissue attached to underlying vein graft from forearm • Type III: Complete degloving of soft tissues; most controversial; function poor even with
successful skin envelope revascularization Treatment: Primary-ray amputation6
n Thumb: Similar to any other type of thumb injury or amputation, warrants every attempt at replantation
CHILDREN n Every attempt should be made to replant no matter the type of amputation, except with
severe crushes or multiple-level injuries. n Distal amputations
• Such amputations may require only percutaneous needle for osteosynthesis. • Nerve repair is not always required. • Direct neurotization may allow normal two-point discrimination.7 • Amputated part may survive as a “composite graft” without the need for microanastomosis
(only in children). Neoepithelialization is often present under eschar. n Better functional results are seen overall, likely because of greater neuronal regenerative
capacity in children. n Inform parents that a replanted finger can grow more slowly than other digits.7
