Necrotizing Cellulitis of the Finger Caused by Ring Embedment Leading to Amputation: A Case Report and Literature Review

TL;DR

A woman's finger was amputated due to severe infection and tissue death caused by a ring that had been embedded for too long.

Contribution

This case report highlights digital amputation as a rare but severe consequence of constrictive ring embedment.

Findings

Prolonged ring embedment led to ischemia, necrosis, and bacterial infection requiring amputation.

Early recognition and intervention are critical to prevent severe vascular compromise.

Reperfusion injury and impaired wound healing further complicated the patient's condition.

Abstract

Constrictive ring embedment can cause progressive ischemia, tissue necrosis, and infection. Although embedded rings have been reported, digital amputation as a direct result is rarely documented.

The authors present the case of a 62-year-old woman who presented to the emergency department with a five-day history of right ring finger cellulitis secondary to prolonged ring erosion extending to the bone. She reported pain, fever, and weakness, and was tachycardic with signs of sepsis. A physical exam revealed crepitus, though radiographs showed no subcutaneous air. Given the severity of ischemic tissue damage and the risk of reperfusion injury, the patient was transferred to the orthopedic service for digital amputation.

The Braden scale, a measurement tool for pressure ulcer risk, identified her as high-risk for pressure ulcers, emphasizing the need for early intervention. Prolonged ring pressure had led to capillary occlusion, ischemia, and necrosis, creating an environment for bacterial infection. Ischemia-driven hypoxia further impaired bacterial clearance and wound healing, while reperfusion injury complicated management.

This case highlights the importance of early recognition and intervention in ring-related ischemic injuries. Clinicians should be aware of the potential for severe vascular compromise, infection, and reperfusion injury in constrictive ring embedment.

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