Flail extremity resulting from constriction band syndrome: Neurovascular implications and surgical management

Abstract

Purpose: Constriction band syndrome afflicting in utero development can lead to devastating and possibly fatal outcomes. A lack of consensus regarding noninvasive testing and surgical modalities is likely secondary to the continued poorly understood pathology. Methods: We provide a case report of a 6-month-old boy who presented with a functional, nonsensate upper limb after surgical release of midhumeral banding at 3 months of age. Results: Exploration revealed intact, albeit atrophic, peripheral nerves with brachial artery disruption above the elbow. Sural nerve grafting was performed and 2-year follow-up demonstrated return of protective sensation in the median nerve distribution with minimal motor return. Conclusion: This case demonstrates that nerves present distal to the original soft tissue insult oppose the idea of failure of nerve formation. Early nerve grafting at the time of initial Z-plasty release may serve to improve long-term functional outcomes.

Keywords:

• Constriction band syndrome
• Streeter’s syndrome

Acknowledgment

Pictures used in this abstract were permitted after obtaining the informed consent by the legal guardian. Identifying details have been omitted.

Ethical Approval: This article does not contain any studies with animal subjects. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.