575251 research-article2015
JHS0010.1177/1753193415575251The Journal of Hand SurgeryShort report letter
JHS(E)
Short report letter
The Journal of Hand Surgery (European Volume) XXE(X) 1–2 jhs.sagepub.com
The reverse glove technique to remove strangulated fingers Dear Sir, Removal of rings or similar objects on swollen fingers is a common problem. These constrictions can usually be removed by various techniques, such as lubrication, cooling, and separation by using string or a rubber band (Belliappa, 1989; McElfresh and Peterson-Elijah, 1991). If the soft tissue of the finger is injured or degloved removal of the constricting object may be difficult. Removal of the surrounding object by using ring cutters, a circular saw or drilling machines has been described. A 7-year-old girl presented with her right middle finger stuck inside a car wheel rim for 2 hours. Since the outer surface of the screw hole was smooth, the patient was able to stick her finger in, but the sharp treaded inner surface of the screw hole led to a circumferential degloving of the soft tissue of the middle finger after multiple attempts to remove her finger. There was substantial swelling and apparent
hypoxia of her middle finger (Figure 1). Further attempts of removal by cooling and lubrication were ineffective. We chose to pull the little finger of the smallest surgical glove available (Size 5.5, Sempermed®, Lohmann & Rauscher, Neuwied, Germany) over the injured finger. By using blunt anatomical forceps, we were able to retract the degloved tissue into the glove and push the ends of the glove through the drill hole (Figure 2). To ease this, the glove was lubricated with oil. As soon as the latex glove was pushed through the hole it was pulled through further, freeing her finger. At operation, both digital nerves were uninjured. The radial artery was not reconstructable, while the ulnar artery was intact and provided sufficient perfusion to the middle finger. Further recovery was uneventful. At a follow-up examination after 1 month the girl had recovered full sensibility and function of her right middle finger. Fingers strangulated and constricted in larger objects, such as a car wheel rim, are very rare and difficult to treat (Chinder et al., 2008; Drewniany et al., 1982). This technique may be useful on other occasions.
Figure 1. Initial view in the emergency room with the finger strangulated in the wheel rim.
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The Journal of Hand Surgery (Eur) Acknowledgements We would like to thank the Professional Fire Brigade of the City of Aachen, Germany, for their kind assistance with this rare case. We would also like to thank the staff of our emergency room (Director J. C. Brokmann MD), the department of anaesthesia, especially Johannes Wendt MD, for their rapid and unrestricted support. Additionally, we would like to thank N. Pallua PhD for his kind help, critical review and B. Ahmed for language editing during the manuscript drafting process.
Conflict of interests None declared.
References Belliappa PP. A technique for removal of a tight ring. J Hand Surg Br. 1989, 14: 127. Chinder PS, Cheah A, Yeo MS, Chong AK. Finger constriction by a brass threading die. J Hand Surg Eur. 2008, 33: 392–3. Drewniany JJ, Palmer AK, Levinsohn EM. An unusual presentation of a ring injury. J Hand Surg Am. 1982, 7: 194–5. McElfresh EC, Peterson-Elijah RC. Removal of a tight ring by the rubber band. J Hand Surg Br. 1991, 16: 225–6.
J. P. Stromps, J. Grasys and H. O. Rennekampff Department of Plastic Surgery, Hand Surgery, Burn Center, University Hospital RWTH Aachen, Germany. Corresponding author: [email protected]
Figure 2. Schematic view of the reverse glove technique: Finger of a surgical glove is pulled retrogradely over the injured finger to retract the injured soft tissue through the hole.
© The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav doi: 10.1177/1753193415575251 available online at http://jhs.sagepub.com
Downloaded from jhs.sagepub.com at CMU Libraries - library.cmich.edu on September 22, 2015
JHS0010.1177/1753193415575251The Journal of Hand SurgeryShort report letter
JHS(E)
Short report letter
The Journal of Hand Surgery (European Volume) XXE(X) 1–2 jhs.sagepub.com
The reverse glove technique to remove strangulated fingers Dear Sir, Removal of rings or similar objects on swollen fingers is a common problem. These constrictions can usually be removed by various techniques, such as lubrication, cooling, and separation by using string or a rubber band (Belliappa, 1989; McElfresh and Peterson-Elijah, 1991). If the soft tissue of the finger is injured or degloved removal of the constricting object may be difficult. Removal of the surrounding object by using ring cutters, a circular saw or drilling machines has been described. A 7-year-old girl presented with her right middle finger stuck inside a car wheel rim for 2 hours. Since the outer surface of the screw hole was smooth, the patient was able to stick her finger in, but the sharp treaded inner surface of the screw hole led to a circumferential degloving of the soft tissue of the middle finger after multiple attempts to remove her finger. There was substantial swelling and apparent
hypoxia of her middle finger (Figure 1). Further attempts of removal by cooling and lubrication were ineffective. We chose to pull the little finger of the smallest surgical glove available (Size 5.5, Sempermed®, Lohmann & Rauscher, Neuwied, Germany) over the injured finger. By using blunt anatomical forceps, we were able to retract the degloved tissue into the glove and push the ends of the glove through the drill hole (Figure 2). To ease this, the glove was lubricated with oil. As soon as the latex glove was pushed through the hole it was pulled through further, freeing her finger. At operation, both digital nerves were uninjured. The radial artery was not reconstructable, while the ulnar artery was intact and provided sufficient perfusion to the middle finger. Further recovery was uneventful. At a follow-up examination after 1 month the girl had recovered full sensibility and function of her right middle finger. Fingers strangulated and constricted in larger objects, such as a car wheel rim, are very rare and difficult to treat (Chinder et al., 2008; Drewniany et al., 1982). This technique may be useful on other occasions.
Figure 1. Initial view in the emergency room with the finger strangulated in the wheel rim.
Downloaded from jhs.sagepub.com at CMU Libraries - library.cmich.edu on September 22, 2015
2
The Journal of Hand Surgery (Eur) Acknowledgements We would like to thank the Professional Fire Brigade of the City of Aachen, Germany, for their kind assistance with this rare case. We would also like to thank the staff of our emergency room (Director J. C. Brokmann MD), the department of anaesthesia, especially Johannes Wendt MD, for their rapid and unrestricted support. Additionally, we would like to thank N. Pallua PhD for his kind help, critical review and B. Ahmed for language editing during the manuscript drafting process.
Conflict of interests None declared.
References Belliappa PP. A technique for removal of a tight ring. J Hand Surg Br. 1989, 14: 127. Chinder PS, Cheah A, Yeo MS, Chong AK. Finger constriction by a brass threading die. J Hand Surg Eur. 2008, 33: 392–3. Drewniany JJ, Palmer AK, Levinsohn EM. An unusual presentation of a ring injury. J Hand Surg Am. 1982, 7: 194–5. McElfresh EC, Peterson-Elijah RC. Removal of a tight ring by the rubber band. J Hand Surg Br. 1991, 16: 225–6.
J. P. Stromps, J. Grasys and H. O. Rennekampff Department of Plastic Surgery, Hand Surgery, Burn Center, University Hospital RWTH Aachen, Germany. Corresponding author: [email protected]
Figure 2. Schematic view of the reverse glove technique: Finger of a surgical glove is pulled retrogradely over the injured finger to retract the injured soft tissue through the hole.
© The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav doi: 10.1177/1753193415575251 available online at http://jhs.sagepub.com
Downloaded from jhs.sagepub.com at CMU Libraries - library.cmich.edu on September 22, 2015
