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Ring Cutters

Mizuho Morrison, DO and Matthieu DeClerck, MD
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Tags MSK · Ortho

Matt and Miz review practical approach to ring cutting. They discuss string-wrap technique, manual and electric ring cutter techniques and pearls and pitfalls along the way.

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Lauren F. -

I had a patient come in with a ring stuck on their finger right after I heard this. I tried the string technique. I couldn't find the green string from the non-rebreather mask that you mention so I tried using flat packing strips thinking that it is thin and maybe it being flat would not bunch up. Unfortunately it didn't work. Afterward I worked 2 hours using a ring cutter only to cut thru 1/3 of the ring. I called several ERs around the area to find out if they had a dremel. I was surprised at their responses. The doctors I talked to didn't seem to think that a dremel was ever appropriate. They said they just always used a ring cutter. One ER I called said that they had a dremel but they only used it "as a very last resort." I sent the patient to that ER and when I followed up found out that they also tried using the a ring cutter for about 1 hour without success. They then tried the string technique using suture string and were successful. They never even attempted the dremel. I was really surprised that they did the string technique with suture material- I would think that the suture string would dig into and potentially cut the patient's finger. You mentioned dental floss not being a good idea and I would think that suture material would be similar. Have you heard of providers using suture material before for this?

Matthieu D. -

Lauren,

Thank you for your email. We love to hear from our listeners even when success is elusive.

While the use of packing material was a good thought I think it most likely lacked the rigidity required to be effective and probably bunched up on you? I am surprised your oxygen masks did not have an elastic band as these are ideal for this technique, alternatives people have used in the past include carpenter string and Penrose drains. I have heard of using suture material and have tried it myself in the past with mixed results. I have found it works if it the suture is thick enough (0-0 Nylon or Silk come to mind).

Either-way, I strongly disagree with the ER doc who told you a circular saw (Dremel) is "never appropriate" because that is just frankly not true. The fact that both you and the ED used a ring cutter for over 3 hours with little headway makes this (I'm assuming thick) ring a great candidate for a power tool as long as it was not make of a ceramic or tungsten material (which can be difficult to impossible to cut through). I know that providers are hesitant to use a Dremel b/c they are concerned about the using a power tool so close to a patient's extremity as I had the same concern when I first looked into using such. I can tell you that I have used a Dremel multiple times with much success (ring is cut off in a matter of minutes rather than hours) and when used appropriately (low rotation setting, keeping the ring/blade wet to dissipate heat, and adding a protective shield between the ring and the digit) this procedure is extremely effective and satisfying.

I encourage you to not be dissuaded from trying again with other materials and/or trying a Dremel saw when appropriate in the future. We recently did a "Procedure Video" on a human model using both the string technique and circular saw that walk the viewer through the steps. Stay tuned!

All the best,

Matthieu DeClerck, MD

Mizuho M., DO -

Hi Lauren, First off, thanks for the comments. I think those ED docs need a UC:RAP subscription! We are happy to hook them up! :) Dremel is standard everywhere and is certainly appropriate. Its not first line as we taught. But it is still an reasonable 3rd line option (after string and ring cutter have failed). The only next best option is calling in Fire department for their heavy metal cutters! Given this is used only is "special" circumstances (ie: Penile rings etc), you can be reassured that Dremels are still used in ED's everywhere (perhaps with the exception of those around you :). I'll have Dr. Matt Declerk weigh in on specifics, but I personally have found the suture can be successful but can be painful for patients b/c it digs into the skin, hence less ideal. Any flat/wider "string" is better than narrow for this reason. Keep the comments coming, and congrats on being better educated that your higher level of care :)

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Better Put A Ring On It Full episode audio for MD edition 196:02 min - 92 MB - M4AHippo UC RAP May 2018 Written Summary 367 KB - PDF

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