Jiang Yongkang, Mao Hailei, Yang Xi, Zhou Shengbo, Ni Feng, Xu Qiming, Wang Bin
Shanghai, People's Republic of China.
From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine; and the Department of Anesthesiology and Critical Care Medicine, Zhongshan Hospital, Fudan University.
Plast Reconstr Surg. 2016 Jul;138(1):164-173. doi: 10.1097/PRS.0000000000002317.
The purpose of this study was to determine the feasibility of single-stage resection for type II congenital constriction rings by means of histologic examination of resected specimens and imaging examination of affected extremities, and to evaluate the appearance and function of the extremities after single-stage surgery.
The features of the skin on the constriction rings and the subcutaneous tissues were identified through continuous sectioning, hematoxylin and eosin staining, and immunohistologic staining of specimens of type II constriction rings obtained by means of surgery. The relationship between the constriction rings and the deep main blood vessels was evaluated using magnetic resonance imaging. Single-stage resection of the constriction band, reduction of the fascial flap, and triangular flap-plasty were performed for 21 patients. The appearance, lymphedema, and movement of the extremities were compared before and after the operation.
Type II constriction rings in the extremities had normal full-layer skin structures. Collagen was found deposited densely at the base of the grooves, but the normal subcutaneous tissue space remained, and the vital nerves and blood vessels were unaffected. Complete resection of the constriction rings was achieved in all 21 patients, and lymphedema subsided 2 months after the operation. No episode of recurrence was found, and limb function was not affected at 26-month follow-up.
Type II congenital constriction rings in limbs possess normal subcutaneous tissue spaces. A single-stage operation, which includes complete resection of the rings, fascial flap reduction, and triangular flap-plasty, could achieve a satisfactory appearance and good function.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究旨在通过对切除标本的组织学检查和对患侧肢体的影像学检查，确定Ⅱ型先天性束带综合征一期手术切除的可行性，并评估一期手术后肢体的外观和功能。
通过对手术获取的Ⅱ型束带标本进行连续切片、苏木精-伊红染色和免疫组织化学染色，明确束带处皮肤及皮下组织的特征。采用磁共振成像评估束带与深部主要血管的关系。对21例患者行束带一期切除、筋膜瓣复位及三角形皮瓣成形术。比较手术前后肢体的外观、淋巴水肿情况及活动度。
肢体Ⅱ型束带处皮肤全层结构正常。在束带沟底部可见致密沉积的胶原，但皮下组织间隙正常，重要神经和血管未受影响。21例患者均成功完整切除束带，术后2个月淋巴水肿消退。随访26个月未见复发，肢体功能未受影响。
肢体Ⅱ型先天性束带综合征皮下组织间隙正常。包括束带完整切除、筋膜瓣复位及三角形皮瓣成形术的一期手术可获得满意的外观和良好的功能。
临床问题/证据级别：治疗性研究，Ⅲ级。
