Saturday, September 5, 2015

Amniotic Constriction Band

Amniotic Constriction Band commonly affects the hand and feet.  I have previously posted on the topic on several occasions as can be viewed HERE.  I wanted to share a few recent cases to demonstrate the different types of Amniotic Constriction Band.

This young child has Amniotic Constriction Band affecting one foot and one hand as depicted below.  The toes are characteristically short and there is a syndactyly (joining of the digits) as well.  As classically noted, the syndactyly is fenestrated such that the tip of the digits are joined but there is an opening closer to the foot.  The hand has a great thumb and a reasonable index finger but the finger is tethered to the remnants of the other digits.

Amniotic Constriction Band of the foot

Amniotic Constriction Band of the hand

Amniotic Constriction Band of the hand, view of the palm

Here is another case of Amniotic Constriction Band demonstrating a slightly different appearance. First, here is the hand prior to surgery.  The thumb is somewhat short, the index finger short and the first webspace (between the thumb and index finger) is tight.  The index finger is bulbous as may be seen in this condition.
Amniotic Constriction Band of the hand, view of the palm.  The pinky is normal but the other digits are short.

Amniotic Constriction Band of the hand.  Note the abnormal index finger with bulbous index finger.

Amniotic Constriction Band of the hand, view of abnormal index finger

Tight first web space with 2 bands of contracture.  Amniotic Constriction Band.
The decision for surgery is based primarily on function but also should consider appearance.  Mom and family were concerned about the length of the thumb and the appearance of the hand.  Certainly, I agreed with the concerns about the thumb because the short thumb and tight webspace limit large object grasp.  And, the bulbous nature of the index finger also limits both function and appearance.  We therefore offered reconstructive surgery.  The webspace was limited in two planes and therefore we used a more complex flap than typical.
Flap raised to reconstruct the first webspace in Amniotic Constriction Band
Flap raised to reconstruct the first webspace in Amniotic Constriction Band. The flap has been laid across the tight web.
Reconstructed hand with deeper webspace and contoured index finger Amniotic Constriction Band

Reconstructed hand with deeper webspace and contoured index finger Amniotic Constriction Band.  The pinky finger is held by the instrument.
Reconstructed hand in Amniotic Constriction Band

Charles A. Goldfarb, MD
My Bio at Washington University
congenitalhand@wudosis.wustl.edu



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