Jimmy Fallon fell while holding a bottle of liquor at a party in his honor Oct. 24, causing a relatively minor injury, but nonetheless leaving him with a bandage — before the one on his other hand was removed. The host of NBC's "Tonight Show" slipped on a rug over the summer and caught his ring on a countertop. In that case, it took specialized microsurgery to repair the "ring avulsion," where the skin and most everything underneath is torn.
Doctors used a piece of vein from his foot to restore blood flow in his hand. In many cases, the repair job is unsuccessful and the patient looses the digit. Fallon's finger may be stiff, but he's lucky to still have a full set of fingers, said Dr. Brian Janz, a plastic and reconstructive surgeon in the LifeBridge Health Center for Hand and Upper Extremity Surgery at Northwest Hospital in Randallstown.
What is ring avulsion, and how does it normally happen?
A ring avulsion injury occurs when the skin is torn around the finger due, in most cases, to the ring getting caught on something with an edge or on a moving piece of machinery. Injuries can range from the skin being torn to the finger being completely ripped off. In mild cases, the skin is torn but the finger does not lose its blood supply. In those cases, sometimes all that is needed is a washout of the wounds and a skin closer. In the severe form, it can be one of the more devastating types of hand injuries. Those injuries can result in the skin, blood vessels and/or nerves being torn. When this happens, as such with Jimmy Fallon, a hand surgeon trained in microsurgical techniques needs to repair those structures to restore viability to the finger.
Although it is a small percentage of the 150,000 avulsion [in which a part of the body is forcibly torn away] and amputation injuries that occur in the U.S. every year, the injuries can be quite devastating. In a significant number of those cases, amputation of the finger may be required.
What does reattachment entail?
Although there are several classifications of a ring finger avulsion, the mild form of the injury usually only requires suturing the skin or fixing the bone if it is broken. In the more devastating form of the injury, repair of the arteries, veins and skin is usually required. In those situations, a microvascular team fixes the veins, arteries and nerves. In many cases, vein grafts from other parts of the body are needed to bridge the traumatized tissue and re-establish a blood supply.
What is the recovery process for ring avulsion, and what are common complications?
The recovery time can be months, even with extensive occupational and hand therapy. It is common to have a very stiff finger after the repair. Once the finger has started to heal, guided and aggressive hand therapy is initiated in order to regain as much motion as possible. Unfortunately, even after a meticulous repair of the vessels and tissue, loss of blood supply to the finger post-operatively can happen. In those situations, a complete amputation of the finger is usually required.
How often can doctors save the finger and restore normal function?
Studies have shown a 90 percent success rate for reattaching a finger when it is an injury from something sharp, like a knife or a blade. When the injury has a larger degree of traumatized tissue [like an avulsion], the success rate drops to 60 percent. Unfortunately, ring avulsion injuries usually result in fairly large areas of traumatized tissue, leading to a lower success rate for saving a finger. In the best-case scenario, motion is restored and the patient has good use of the hand. As the level of traumatized tissue increases, so does the possibility of permanent post-operative stiffness, resulting in decreased strength and loss of motion. I suspect Fallon will have some stiffness with the finger, but he can still count to 10 using both hands.