One stage release of circumferential constriction band in upper limb with multiple Z-plasty technique: a case report

INTRODUCTION: 

Congenital constriction band is an uncommon congenital abnormality with multiple disfiguring and disabling manifestations. The widely known management for the correction of congenital constriction band especially in circumferential constriction band is done in a multistage release of constriction band to eluding vascular and lymphatic embarrassment. The purpose of this case report was to present the outcome of one-stage release in terms of safety and aesthetic appearance.

CASE DESCRIPTION:

Women 28 year old came to outpatient plastic surgery clinic presented with circumferential constriction with no functional disability in her right arm since birth. Excision based on design of multiple Z-Plasty is started 2 cm proximal and distal from constricted band. The multiple Z- Plasty flaps are transposed around each other, changing the direction of the constriction band.  Postoperatively, the extremity circulation was normal, and no edema was observed. The range of motion is within normal limits and aesthetically acceptable for the patient.

DISCUSSION: Patterson classified constriction ring syndrome into four types, and type II is the most common. In type II Paterson , there are normal full-layer skin structures and no important nerve or blood vessel was affected so an incision completely encircling an extremity would not interfere with distal circulation and provided strong evidence that one-stage resection of constriction band could be performed. Using multiple Z-Plasty for constriction band release leads to improvement of functional and cosmetic appearance of the defect.