Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Liliencronstr. 130, 22149 Hamburg, Germany.
J Plast Reconstr Aesthet Surg. 2013 Aug;66(8):1117-22. doi: 10.1016/j.bjps.2013.04.042. Epub 2013 May 6.
In amniotic band syndrome (ABS) constriction rings affecting the limbs are regularly seen at birth. Circular resection and closure with multiple Z-plasties has been described as the treatment of choice. However, direct circular closure creating linear circumferential scars might replace multiple Z- or W-plasties to reduce scars and improve aesthetic outcome.
From 2000 to 2009 we treated 160 patients with ABS. In 43 cases release of isolated constriction rings was performed by circular excision and closure. Constriction rings were completely resected and skin closure could be performed without Z-plasty in all cases. Data from follow-up of all cases were reviewed and photographs and recordings reassessed. The median age at operation was 14.3 months (range 2-32). Constriction rings were localised on the upper arm in five patients, the lower arm in five, the wrist in two and at the metacarpal level in five. At the lower extremity the thigh was affected in three and the lower leg in 23 patients.
In the 16 cases of the first treatment period from 2000 to 2004, average follow-up was 6.5 years (range 5.1-10.3). We observed two minor complications following 43 operations (wound dehiscence and secondary healing). No formation recurrence of banding was seen. Aesthetic outcome was overall good.
We found excellent aesthetical and functional results following change of treatment from multiple Z-plasties to linear circumferential closure. Scars were generally less noticeable and no recurrence or scar constriction could be detected with growth. However, radical excision of all constricting tissues prior to wound closure is mandatory.
在羊膜带综合征（ABS）中，出生时经常会看到影响四肢的缩窄环。已经描述了圆形切除和多个 Z 成形术闭合作为首选治疗方法。然而，直接进行圆形闭合以形成线性环状瘢痕可能会取代多个 Z 形或 W 形皮瓣，以减少瘢痕并改善美观效果。
我们在 2000 年至 2009 年间治疗了 160 例 ABS 患者。在 43 例中，通过环形切除和闭合来释放孤立的缩窄环。所有病例均完全切除缩窄环，无需 Z 成形术即可进行皮肤闭合。对所有病例的随访数据进行了回顾，并重新评估了照片和记录。手术时的中位年龄为 14.3 个月（范围 2-32 个月）。在 5 例患者中，缩窄环位于上臂，5 例位于前臂，2 例位于腕部，5 例位于掌骨水平。在下肢，大腿受影响 3 例，小腿受影响 23 例。
在 2000 年至 2004 年的第一个治疗期间的 16 例病例中，平均随访时间为 6.5 年（范围 5.1-10.3 年）。我们观察到 43 次手术中有 2 例出现轻微并发症（伤口裂开和二期愈合）。未发现带束的复发。总体上美容效果良好。
我们发现，将治疗方法从多个 Z 成形术改为线性环状闭合后，获得了极佳的美容和功能效果。疤痕通常不太明显，并且在生长过程中未发现复发或疤痕收缩。然而，在关闭伤口之前，必须彻底切除所有限制组织。
