Article

Replanting complete ring avulsion injuries remains a challenge for hand surgeons.
The prognosis depends on achieving satisfactory function. We present the results
of our 16 years' experience with managing this type of injury. Our cohort
consisted of 83 cases of complete ring avulsion injuries in patients with an
average age of 23.5 years, treated in a Hand Emergency Unit between 1998 and
2014. Seventy-two were replanted. A vein graft was used in 57 cases to bridge the
arterial injury and direct anastomosis was performed in 15 cases. Forty-one cases
were a microsurgical success. Twenty-four patients were reviewed with an average
follow-up of 87 months. The mean of total active motion was 164 degrees , with 64
degrees range of motion in the proximal interphalangeal joint on average. The
two-point discrimination for sensitivity averaged 6mm. Two cases of severe cold
intolerance were noted. Using a graft for vascular repair increases the odds of
microsurgical success. The functional outcome depends on the condition of the
proximal interphalangeal joint. Cold intolerance and lack of sensitivity have
little effect on the functional outcome and patient satisfaction. Replantation of
complete digital avulsion injuries should be attempted. Amputation at the
metacarpal base is better discussed later on, after the initial surgery.
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Langue : ANGLAIS