PubMed · 9654952
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P A Levy. 1998. Amniotic bands.. https://doi.org/10.1542/pir.19-7-249
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In a 23-week fetus with a large left-sided pleural effusion a double pigtail pleuro-amniotic shunt was inserted uneventfully. A healthy infant was delivered at 38 weeks' gestation. One end of the shunt was in the thoracic cavity but the other end was found wrapped around the upper arm resulting in a constriction band. There was no impairment of the vascular supply to the limb or in its motor or sensory function and by 6 months of age there was only a faint ring still apparent around the upper arm.
This report presents a case of a male newborn with a severe circumferential amniotic band, treated by single-stage excision of the ring, and microvascular venous anastomosis between the proximal and distal parts of the affected site. No complications were encountered. A microsurgical approach to improve the circulation may be useful in some cases.
Twenty patients with congenital upper limb amputations caused by constriction rings were reviewed to classify the pattern of these amputations. In the 20 patients studied, 31 upper limbs had congenital amputations. The pattern of amputation was classified into three types. Proximal upper limb amputation was considered type I and was only seen in one limb. The most common pattern of amputation was digital amputation associated with "coning" or "superimposition" of the digits (type II) and was seen in 20 hands. Type II amputations were subclassified according to the involvement of all, ulnar, radial, or central digits by the constriction ring. In type III amputations (N = 10 limbs), there was no associated coning or superimposition of the digits. This type of amputation was subclassified into type IIIA (multiple-digit amputations within the same hand) and type III B (single-digit amputation). Associated anomalies are reviewed and the pathogenesis of constriction rings is discussed.