Pediatric Ring Avulsion Injuries: A Systematic Review of Surgical and Functional Outcomes and Gaps in Cosmetic and Psychosocial Reporting

Pediatric ring avulsion injuries are rare but potentially devastating injuries that may result in degloving, vascular compromise, or complete digital amputation.Existing literature primarily focuses on surgical management and functional outcomes, while the cosmetic and psychosocial impact of these injuries remains poorly characterized.A systematic literature review was conducted using PubMed, Embase, and Google Scholar to identify published reports of pediatric ring avulsion injuries through October 2026.Search terms incorporated "ring avulsion," "digital avulsion," "finger avulsion," "digital degloving," and related terms combined with pediatric age-related terms.Studies were included if patients were younger than 19 years and sufficient information was available to confirm the injury mechanism and extract relevant clinical data.Studies were not excluded solely because injury classification or individual outcomes were incompletely reported.Nineteen publications met the final inclusion criteria.Data collected included demographics, mechanism and extent of injury, injury classification, management, functional outcomes, and reporting of cosmetic and psychosocial outcomes.The 19 included studies described at least 40 pediatric patients with ring avulsion injuries.Injury severity ranged from preserved circulation to complete degloving or amputation and was characterized using the Urbaniak, modified Kay, and other classification systems when reported.Microsurgical revascularization or replantation was frequently attempted for severe injuries, although some patients required primary amputation or subsequent revision following unsuccessful salvage.Lower-grade injuries generally required less extensive reconstruction.Functional recovery varied with injury severity and the extent of vascular, tendon, nerve, and skeletal damage.Although successful replantation was reported in several severe cases, digit survival did not consistently translate to restoration of normal function.Reported outcomes included digit survival, range of motion, grip strength, sensory recovery, cold intolerance, and cosmetic appearance.Patient-centered outcomes were inconsistently assessed, with limited reporting of cosmetic satisfaction and psychological recovery and little to no formal assessment of body image or health-related quality of life.Pediatric ring avulsion literature remains limited to case reports and small case series, with substantial variability in injury severity, management, and outcome reporting.Although microsurgical techniques have enabled successful digit salvage in selected patients, functional recovery remains variable.Despite the potential psychological impact of visible hand deformity during childhood and adolescence, cosmetic and psychosocial outcomes remain underreported.Future studies should incorporate standardized functional measures, patient-reported outcomes, and psychosocial assessments to better characterize the long-term effects of these injuries.