Surgical treatment of congenital constriction ring syndrome in the hand

Objective Congenital constriction ring syndrome (CCRS) is among the most common congenital deformities of the hand.However,few techniques have been described for correction of this anomaly,and none of these techniques could provide complete correction of the deformity.We describe our two-stage surgical strategy and report the treatment outcomes.Methods From January 2007 to January 2012,50 children (195 digits) with CCRS in the hand underwent two-stage surgery.The follow-up period averaged 23.9 months.At stage I,following excision of the dorsal fibrotic constriction ring,the resulting defect was filled with a subcutaneous fascial flap.In the absence of distal finger lymphedema,skin closure was done with Z-plasty.When there was obvious lymphedema,a transverse incision was used.Similar procedures were done on the volar aspect of the finger at stage Ⅱ 6 months after the first surgery.Appearance,scar formation and complications were observed postoperatively.Results All the patients underwent the two-stage operation.Acrosyndactyly was present in 54％ (27/50) of the patients.Lymphedema occurred in 28％ (14/50) of the cases.In 78.5％ (153/195) of the digits,a normal finger contour was obtained,with conplete elimination of the sandglass deformity caused by the constriction ring.The scars were found to be esthetically acceptable in 88％ (44/50) patients.There were no complications like flap loss or finger necrosis.Further surgical correction was deemed necessary in 6 cases (12％).Conclusion Two-stage surgical resection of the constriction ring can avoid the potential risk of circulation compromise.Complete excision of the constriction ring and filling the resulting circular groove with subcutaneous fascial flaps are key to achieving a normal contour.Selection of the incision depending on the degree of lymphedema helps to improve the results. Key words: Hand deformities, congenital;  Surgical procedures, operative;  Constriction ring syndrome;  Acrosyndactyly