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