From the Divisions of Plastic and Orthopaedic Surgery, Toronto Western Hospital Hand Clinic, University Health Network, University of Toronto; Orthopaedic Surgery Residency Program, WellSpan York Hospital; and Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine.
Plast Reconstr Surg. 2022 Apr 1;149(4):774e-778e. doi: 10.1097/PRS.0000000000008954.
Many patients with constriction band syndrome will seek treatment to improve limb function and cosmesis. Although several techniques for excision are reported, cosmetic and functional deficits can persist, including hourglass deformity, lymphedema, and inadequate band excision with resultant neurovascular compromise, which may lead to revision surgery, including amputation. The authors present a novel technique that uses multiple continuous opposing Y-to-V-plasties in a single or staged manner to correct extremity constriction bands.
Seven patients with 10 involved extremities were included in this retrospective case series. Patient demographics, associated abnormalities, and operative indications were collected from medical records. The primary outcome measures were primary wound healing and release of the constriction band. Secondary outcomes measures were perioperative complications and the need for revision surgery.
All patients achieved primary closure with excellent healing in one or two stages. No infections or scar complications occurred, and no revision surgery of the band was required. One patient had mild indentation of scar tissue after their second stage, which improved with scar massage. One patient who had preoperative sciatic compression neuropathy and an insensate foot secondary to band constriction developed chronic calcaneal osteomyelitis requiring a subsequent Syme amputation. Postoperative lymphedema occurred in two patients, which resolved with the use of compression bandages over several weeks.
Use of multiple continuous opposing Y-to-V-plasties is a safe and effective technique for adequate constriction band excision without residual hourglass deformity and good functional outcomes for patients with partial or circumferential constriction bands.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
许多患有紧缩带综合征的患者会寻求治疗以改善肢体功能和美观。尽管有几种切除技术报道，但仍会存在美容和功能缺陷，包括沙漏畸形、淋巴水肿和因切除不足导致的神经血管受损，这可能导致需要进行修正手术，包括截肢。作者介绍了一种新的技术，该技术使用多个连续的对向 Y-V 皮瓣成形术来一次或分期纠正四肢的紧缩带。
本回顾性病例系列纳入了 7 名患者的 10 个受累肢体。从病历中收集患者的人口统计学数据、相关异常和手术指征。主要结局指标是一期伤口愈合和紧缩带松解。次要结局指标是围手术期并发症和修正手术的需求。
所有患者均在一期或二期内实现了一期闭合，愈合良好。无一例发生感染或疤痕并发症，也无需对紧缩带进行修正手术。有 1 例患者在第二期后出现轻微的疤痕组织凹陷，通过疤痕按摩后得到改善。有 1 例患者术前患有坐骨神经压迫性神经病，足部因紧缩带而感觉丧失，发展为慢性跟骨骨髓炎，需要随后进行 Symes 截肢。术后有 2 例患者发生淋巴水肿，通过数周的加压绷带治疗后得到缓解。
使用多个连续的对向 Y-V 皮瓣成形术是一种安全有效的技术，可以充分切除紧缩带，避免残余沙漏畸形，并为部分或环状紧缩带患者带来良好的功能结果。
临床问题/证据水平：治疗，IV。
