Ring Removal


INDICATIONS
  • Removal of a ring from a swollen digit
CONTRAINDICATIONS
  • Use the ring-cutting technique if there are lacerations or neurovascular compromise.
TECHNIQUE
  • When using the string technique, after elevating the digit, wrap it in a spiral ligature from the tip of the digit to the ring. 2 mm umbilical tape or 0-gauge or larger braided suture with a tapered needle is best, but other materials may be used. Perform the wrapping with enough tension so that the interstitial fluid gently moves under the ring but not so tightly as to obstruct arterial flow.

 

  1. Wrap the elevated digit in a spiral ligature with larger braided suture using a tapered needle from the tip of the digit to the ring.
    PITFALL: Avoid the use of monofilament or thin sutures because they can tear through the skin.


     

  2. Pass the end of the suture beneath ring without piercing the skin.


     

  3. Slowly unwind suture from under the ring, pushing the ring forward as it unwraps.



     

  4. Rubber glove technique.
    When using the rubber glove technique and the involved digit is markedly swollen, remove a “finger” from a small, powder-free, latex surgical glove, and pull it onto the digit. When the rim of the glove finger nears the ring, pass a small, curved forceps under the proximal side of the ring to grasp the latex, and draw it between the ring and the digit. Allow the latex to compress the swollen digit uniformly until the ring can be passed over the lubricated glove and digit.

    PITFALL: Watch for latex allergy, which can worsen swelling.



     

  5. Ring cutter.
    Pick the thinnest, least ornate, or most accessible portion of the ring for the cutting site. The ring cutter is illustrated. The digit guard of the ring cutter is passed under the ring and protects the digit from injury.


    Pick the thinnest portion of the ring as the cutting site, and use pliers if necessary to compress the ring if you cannot pass the digit guard under the site.


    PITFALL: Avoid excessive pressure and trauma to the digit. Even with mild pressure, the patient must be warned that that he or she may experience some discomfort.

    Continually rotate the saw blade using the lever to sever the ring without injuring the skin.



    Grasp the two ends of the divided ring with pliers, and pull them apart to remove the rings from the finger.


     


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