title: Ten-year experience with one-step correction of constriction rings by complete circular resection and linear circumferential skin closure.
abstract: 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.
authors: Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Liliencronstr. 130, 22149 Hamburg, Germany. r.habenicht@kkh-wilhelmstift.de
authors: R
authors: R
authors: Habenicht
authors: W
authors: W
authors: Hülsemann
authors: J A
authors: JA
authors: Lohmeyer
authors: M
authors: M
authors: Mann
mesh_terms: D000652:Amniotic Band Syndrome / Q000601:surgery*; D002675:Child, Preschool; D004954:Esthetics; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D038061:Lower Extremity Deformities, Congenital / Q000601:surgery; D008297:Male; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D038062:Upper Extremity Deformities, Congenital / Q000601:surgery
keywords: Amniotic band syndrome; Amniotic disruption sequence; Congenital constriction band syndrome; Constriction ring; Streeter's dysplasia; Z-plasty