Alternative Technique for Ring Removal
ABSTRACT & COMMENTARY
Source: Thilagarajah M. An improved method of ring removal. J Hand Surg 1999;24B:118-119.
Thilagarajah describes another simple, and perhaps more comfortable, technique to remove a ring from a swollen or oversized finger. First, a length of ribbon gauze 1.25 cm in width is passed under the ring. A paper clip can be used to hook the edge as it passes under the band. Next, the gauze distal to the ring is wrapped around the finger, using firm technique and overlapping each turn one-half the width of the gauze. The wrapping continues until the narrower part of the digit is reached. Finally, the proximal end of the gauze wrap is grasped and unwound with a uniform tension simultaneously applied in a proximal-to-distal direction.
Comment by Richard Harrigan, MD, FAAEM, FACEP
The above described method is a variation of the "string wrap method" described in the Roberts and Hedges text.1 Intuitively, it seems more comfortable and less time-consuming than using string or suture. There are several ways to approach such a problem, the easiest being to lubricate the ring, and the least desirable (from the patient’s point of view) being the ring cutter.1 Other alternatives include the use of 2.0 surgical silk in lieu of string (purported to be less traumatic than string), and the passage of an intact, wide rubber band beneath the ring. The latter method, performed on a lubricated digit, involves subsequently pulling the ring distally while holding both loops, and moving circumferentially around the digit. The authors remind us that a digital block may be necessary if the procedure becomes too painful. Whereas I am still awaiting a chance to try this new technique on a real patient, I have found that the gauze technique described above works well on rings that are not stuck. Anecdotally, simple 4 ´ 4 gauze is not strong enough; the gauze found in cling wraps seems stronger and better suited.
Reference
1. Rudnitsky GS, Barnett RC. Soft tissue foreign body removal. In: Roberts JR, Hedges JR. Clinical Procedures in Emergency Medicine, 3rd ed. WB Saunders; Philadelphia; 1998:614-633.
Acceptable methods for removal of rings that are stuck on a digit include all of the following except:
a. lubrication and distal traction.
b. the string wrap method.
c. the gauze wrap method.
d. local anesthetic injection of the PIP joint capsule.
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