Definition
Deep skin crease encircling digit
Incidence
1: 15 000
Aetiology
? Due to amniotic adhesions formed after haemorrhage in the distal rays
40% associated with other congenital hand abnormality
Streeter's syndrome
- hand and feet amniotic bands
Patterson Classification
1. Simple Ring
- transversely around limb
2. Deep Ring
- deformity, associated with lymphoedema of distal part
3. Acrosyndactyly
- fingers formed, then bands form constriction
- proximal fingers open, distal closed
3. Intrauterine amputations
- usually distal
- usually central fingers
Management
Simple incomplete bands
Observe
Vascular compromise with complete bands
Concept
Release via multiple Z plasties
- bands with distal lymphoedema
- if band deep may need to be released as staged procedure
Technique
- excise a 1- 2 mm margin of normal skin and subcutaneous tissue to minimize the risk of recurrence
- resect all constricted fascia and muscle
- identify and protect neurovascular structures
- debulk excess subcutaneous tissue, especially dorsum fingers
- close the skin with multiple Z-plasties