Asian Journal of Case Reports in Surgery

Background: Ring avulsion injuries are severe hand traumas characterised by circumferential degloving of the digit and are frequently associated with vascular, neural, tendinous, and skeletal damage. Although digital salvage remains a primary objective, achieving satisfactory skin pliability and sensory recovery is crucial for long-term functional outcomes, particularly in young and active patients. The present study reports our experience using a refined superficial inguinal flap technique derived from the classic MacGregor flap.

Methods: A retrospective review was conducted on 10 patients aged 8-25 years who sustained ring avulsion injuries. Initial management included meticulous debridement, assessment of tissue viability, skeletal stabilisation when required, and tendon repair. Soft-tissue coverage was achieved using a modified superficial inguinal flap in eight cases. One patient underwent skin grafting after directed wound granulation, and one patient was treated using artificial dermis followed by skin grafting.

The flap was harvested as a broad-based random-pattern flap and elevated strictly within the superficial fascial plane while preserving the main trunk of the superficial circumflex iliac artery at the donor site. This modification aimed to provide a thinner flap and reduce the need for secondary debulking procedures.

Results: All patients reconstructed with the superficial inguinal flap achieved durable coverage with preservation of finger mobility and satisfactory skin pliability. Progressive sensory recovery was observed, evolving from protective sensation to discriminative sensibility during follow-up.

Although flap thinning was performed at harvest, secondary debulking procedures were required in most patients to optimise contour and function.

The patient treated with skin grafting developed significant stiffness and poor tissue mobility due to adhesion between the graft and underlying osteotendinous structures. The artificial dermis provided improved tissue suppleness compared with skin grafting alone; however, sensory recovery remained limited.

Conclusion: The superficial inguinal flap harvested at the level of the superficial fascia represents a reliable salvage option for ring avulsion injuries in young patients. By providing well-vascularised, pliable tissue capable of progressive sensory recovery, it appears to offer superior functional outcomes compared with skin grafting. Despite the need for staged reconstruction and occasional secondary debulking, this technique provides an excellent balance between durability, pliability, and sensibility.