Ten-year experience with one-step correction of constriction rings by complete circular resection and linear
R Habenicht1, W Hülsemann, J A Lohmeyer
1Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Liliencronstr. 130, 22149 Hamburg, Germany. r.habenicht@kkh-wilhelmstift.de
Insights
Linear closure is an effective treatment for amniotic band syndrome (ABS) constriction rings, offering improved aesthetics and reduced scarring compared to Z-plasties. This method ensures no recurrence and is recommended for better patient outcomes.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Congenital Malformations
Background:
- Amniotic band syndrome (ABS) frequently causes limb constriction rings at birth.
- Traditional treatment involves circular resection with Z- or W-plasties.
- Linear circumferential closure offers a potential alternative to minimize scarring.
Purpose of the Study:
- To evaluate the efficacy of direct circular closure for ABS constriction rings.
- To compare aesthetic and functional outcomes with traditional Z-plasty techniques.
- To assess scar formation and recurrence rates after linear closure.
Main Methods:
- Retrospective review of 43 ABS patients treated with circular excision and closure (2000-2009).
- Complete resection of constriction rings, with closure achieved without Z-plasty.
- Analysis of follow-up data, including photographs and recordings.
Main Results:
- No recurrence of banding observed in any cases.
- Two minor complications (wound dehiscence, secondary healing) occurred in 43 operations.
- Overall good to excellent aesthetic and functional outcomes reported.
Conclusions:
- Linear circumferential closure provides excellent aesthetic and functional results for ABS.
- This technique results in less noticeable scars and no growth-related constriction.
- Mandatory radical excision of all constricting tissues is crucial for successful outcomes.
Background:
In amniotic band syndrome (ABS) constriction rings affecting the limbs are regularly seen at birth. Circular resection and closure with multiple Z-plasties has been described as the treatment of choice. However, direct circular closure creating linear circumferential scars might replace multiple Z- or W-plasties to reduce scars and improve aesthetic outcome.
Methods:
From 2000 to 2009 we treated 160 patients with ABS. In 43 cases release of isolated constriction rings was performed by circular excision and closure. Constriction rings were completely resected and skin closure could be performed without Z-plasty in all cases. Data from follow-up of all cases were reviewed and photographs and recordings reassessed. The median age at operation was 14.3 months (range 2-32). Constriction rings were localised on the upper arm in five patients, the lower arm in five, the wrist in two and at the metacarpal level in five. At the lower extremity the thigh was affected in three and the lower leg in 23 patients.
Results:
In the 16 cases of the first treatment period from 2000 to 2004, average follow-up was 6.5 years (range 5.1-10.3). We observed two minor complications following 43 operations (wound dehiscence and secondary healing). No formation recurrence of banding was seen. Aesthetic outcome was overall good.
Conclusions:
We found excellent aesthetical and functional results following change of treatment from multiple Z-plasties to linear circumferential closure. Scars were generally less noticeable and no recurrence or scar constriction could be detected with growth. However, radical excision of all constricting tissues prior to wound closure is mandatory.
