Class IIA ring avulsion injuries: an absolute indication for microvascular repair.

The class II ring avulsion category, includes those patients in whom only digital arteries are damaged but all other structures are intact and functional (here labeled class IIA). Current literature suggests this is a rare lesion. Seven patients with this specific injury in whom the affected digits were nonviable are reported. Four of the seven were misdiagnosed on initial emergency room evaluation. Two did not seek additional medical attention and the condition progressed to necrosis and amputation. The other two, who sought additional treatment because of progressive ischemia, and three additional patients who were correctly diagnosed on initial examination underwent simple digital arterial repair. All digits operated on survived and demonstrated near normal function. Since failure to operate results in digital loss, this is an absolute indication for microvascular repair.