Amniotic Bands

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