Department of Othopaedic and Spine Surgery, Fukuoka Children's Hospital, Higashi-ku, Fukuoka, Japan.
Department of Othopaedic Surgery, Saga Handicapped Children's Hospital, Kinryu-machi, Saga, Japan.
J Hand Surg Asian Pac Vol. 2023 Jun;28(3):315-320. doi: 10.1142/S2424835523500327. Epub 2023 May 5.
Congenital constriction ring syndrome (CCRS) is a rare condition diagnosed at birth characterised by deformation due to a constriction ring. The usual treatment for CCRS involves excision of the constriction ring and suture of the skin incorporating a Z-plasty to prevent scar contracture. A Z-plasty often results in an unsightly scar. In order to avoid this, we performed linear circumferential skin closure (LCSC). The aim of this paper is to report the outcomes of LCSC for CCRS. We retrospectively investigated all patients with CCRS who underwent LCSC between 2002 and 2020. Two linear incisions were placed proximal and distal to the constriction ring in parallel, and the constriction ring was excised carefully so as not to damage nerves or vessels. The deep subcutaneous and dermis layers were sutured. The skin was closed using adhesive tape. Two-stage surgery was performed in two patients with severe CCRS of the lower leg to avoid problems with distal circulation. Patients were followed up for at least 1 year and assessed for complications and quality of scar. We performed LCSC for 31 sites in 19 patients, including one forearm, 14 fingers, 10 lower legs and six toes. The median age at the operation was 16 months (range: 4-175). The median follow-up period after surgery was 5.8 years (range: 1.9-16.0). The linear surgical scar had healed well in all patients and there were no complications. There was no recurrence of the constriction ring and no scar hypertrophy, though we did not perform fat mobilisation in all cases. None of the patients required additional surgery and the aesthetic outcome of the linear circumferential surgical scar was maintained at the final observation. Treatment for CCRS using LCSC resulted in no complications, no recurrence of constriction and an excellent aesthetic outcome. Level IV (Therapeutic).
先天性缩窄环综合征（CCRS）是一种罕见的出生时即诊断出的疾病，其特征为缩窄环引起的变形。CCRS 的常规治疗包括切除缩窄环和缝合皮肤，采用 Z 成形术以防止瘢痕挛缩。Z 成形术通常会导致难看的瘢痕。为避免这种情况，我们采用了线性环形皮肤闭合术（LCSC）。本文旨在报告 LCSC 治疗 CCRS 的结果。我们回顾性调查了 2002 年至 2020 年间接受 LCSC 治疗的所有 CCRS 患者。在缩窄环的近侧和远侧平行放置两条线性切口，并小心切除缩窄环，以免损伤神经或血管。深皮下和真皮层缝合。使用胶带闭合皮肤。两名小腿 CCRS 严重的患者进行了两阶段手术，以避免远端循环问题。患者至少随访 1 年，评估并发症和瘢痕质量。我们对 19 例患者的 31 个部位进行了 LCSC，包括 1 例前臂、14 个手指、10 个小腿和 6 个脚趾。手术时的中位年龄为 16 个月（范围：4-175）。手术后的中位随访时间为 5.8 年（范围：1.9-16.0）。所有患者的线性手术瘢痕均愈合良好，无并发症。所有病例均未出现缩窄环复发和瘢痕增生，但并非所有病例均行脂肪动员。患者均无需进一步手术，线性环形手术瘢痕的美学效果在最终观察时得以维持。LCSC 治疗 CCRS 无并发症、无缩窄环复发，且美学效果良好。IV 级（治疗）。
