Tuesday, January 7, 2014

Amniotic Constriction Band

Amniotic constriction band is an uncommon condition about which I have previously blogged  ACB Blog Link .  There are numerous good general descriptions on the Internet including the following:

Shriners Link
Medline Plus

The difficulty is that there is little precise information on the upper extremity and hand finding in Amniotic Constriction Band.  There are numerous reasons for this.  First, there are a large number of names for this condition which can make searching for patients/ information difficult.  Alternatives include amniotic band syndrome, amniotic band sequence, constriction band syndrome, Streeters, and more.  I like Amniotic Constriction Band alone as I feel that it is descriptive and accurate.  It is not a syndrome.

The second issue is that almost no 2 patients with Amniotic Constriction Band are alike.  The fingers affected, the severity, the other limbs affected, the other findings...  all are different.  There are, however, some similarities.

  1. More than 1 extremity involved.  It is very uncommon to find a patient with only one limb or one hand involved.
  2. There are a few typical findings although, again, every patient is different and a patient may have 1 or all 3 of these:
  3. Constriction band on calf.
    1. Constriction bands or indentations.  These can be anywhere including fingers, toes, the lower leg, the arm.  If tight enough, this can cause a major problem past the band due to swelling.  These can also affect muscle quality and strength.
    2. Syndactyly.  This type of syndactyly is very different from other children with a developmental syndactyly. See my previous blogs on typical, congenital syndactyly.  Syndactyly Posts  Typically, in Amniotic Constriction Band, syndactyly is fenestrated (there is some space between the fingers).  Even if the fingers are not conjoined, there can be narrowing of the web space.
      Syndactyly and fingertip amputations, a classic appearance in Amniotic Constriction Band.
    3. Amputations.  This can involve the entire arm or leg but typically involves the fingers and most commonly the index, long, and ring fingers
Terry Light nicely summarized some of these findings in an article available online.  Light article

Below is a recent patient with Amniotic Constriction Band.  The patient has multiple extremities affected including feet (with syndactyly- fenestrated) and hand.  A first surgery more than one year ago separated the hand.   Here are preoperative images of the affected hand and foot.
Not the toe syndactyly.  There are spaces between the toes (fenestrations) that are consistent with the diagnosis of  Amniotic Constriction Band

Preoperative view of  the hand in Amniotic Constriction Band

Another preoperative view of the hand in Amniotic Constriction Band


Today the hand is in much better position and the primary issue is limited grasp due to short digits related to the amputations.  The patient is brought to the operating room to deepen the first webspace.  This area is critical to allow large object grasp.  There are many techniques but I favor a simply approach and we deepened using z- plasties which are skin rearrangements.


Amniotic Constriction Band with tight first webspace

Amniotic Constriction Band with tight first webspace

Amniotic Constriction Band with tight first webspace
After multiples z- plasties.  Note the deeper space which will allow larger object grasp.
Again, multiple z-plasties are visible.



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