REMOVAL OF RINGS Indications Strangulating ring on a digit Complications Vascular compromise Trauma to digit Procedure String pull ( Fig 130.41A ) Explain the procedure and position the patient comfortably Cleanse the area and consider a digital block Use a string or heavy suture Place one end of the string under the ring and pull it through Place a small amount of lubricating ointment at the distal end of the ring Grasp both ends of the suture to 10 cm from the ring Pull the suture in a circular motion Continue slipping the suture around the ring as it gradually moves along the finger After the ring is removed, cleanse the digit and apply a dressing if needed String compression of skin ( Fig 130.41B ) Explain the procedure and position the patient comfortably Cleanse the area and consider a digital block to reduce pain and facilitate getting the string under the ring Use string or 3-0 silk suture Alternatively, you can use ribbon gauze or an umbilical tape ( Fig 130.41C ) The string at the proximal end should be placed under the ring Then wrap the string/suture on the distal side around the finger Continue to wrap the string tightly to compress the soft tissue swelling on the finger until it covers the proximal interphalangeal joint Grasp the ring, and while exerting a rotary twisting movement, pull the ring over the string/suture and off the finger If this cannot be done, pull on the string that is under the proximal end in a circular unwrapping fashion to assist in pulling the ring off the finger After the ring is off, remove the remaining suture from encircling the finger Cleanse the digit and apply a dressing if needed Ring cutting ( Fig 130.41D ) Explain the procedure Position the patient supine or sitting Cleanse the area When there is considerable pain or swelling, perform a digital block to achieve anesthesia of the finger Insert the ring-cutter guard between the ring and the finger Place the blade on the ring Grasp the handle of the ring cutter and apply pressure while rotating the blade If the ring is made of hard metal, cutting may be difficult and friction will cause the ring to heat If this occurs, stop until the metal cools After the ring is completely cut through, pull the ring apart manually or with a hemostat and remove from the digit A thick ring may require two cuts if you cannot pry it open after one cut Cleanse the digit and apply a dressing if necessary FIGURE 130.41 Removal of a ring from a digit REMOVAL OF A BODY PIERCING Indications Infection Allergic reaction Persistent bleeding Edema Keloid formation Complications Infection Procedure Traditionally, a typical earring consisted of a stud and a backing However, there are now many types of piercing jewelry Labret studs and Barbell studs consist of a straight bar with a ball threaded onto one or both ends, respectively A captive bead ring is a ring that holds a single ball in place by tension A bead ring is different in that it has one ball that is fixed and one that is removable To remove a stud, hold the bar with forceps and unscrew the ball To remove a captive bead ring, use two sets of forceps (or other tool) to hold onto the ring on either side of the ball and release the tension that holds it in place which will then dislodge it To remove a bead ring, simply unscrew the removable ball If the piercing is near the mouth or nose, use extra caution to avoid aspiration A portion of the jewelry may be imbedded in the soft tissues and not easily available This may require an incision to expose the necessary portions, in which case, consider pharmacologic anxiolysis or analgesia prior to the procedure (see Chapter 129 Procedural Sedation ) The application of anesthetic cream may be of value in anesthetizing the superficial epidermis but may be inadequate anesthesia for a deeply embedded piercing Distraction techniques and the use of child life may also help to reduce anxiety and pain Immediately prior to beginning the procedure, position the child to maximize access to the area Have an assistant stabilize the patient at the site of the procedure and restrain as necessary Cleanse the area thoroughly and use aseptic technique Infiltrate the area of the piercing with local anesthetic (lidocaine 1%) injection Consider a field block or nerve block if appropriate In the case of a traditional stud earring with backing that is embedded in an earlobe, use your non-dominant hand to gently apply pressure to the anterior aspect of the earlobe to force the earring back through or close to the opening on the posterior aspect of the earlobe It may be necessary to apply