Advanced Management of Distal Lower Extremity Congenital Constriction Bands for Foot Salvage

Abstract

Constriction ring syndrome is a rare congenital condition characterized by the formation of fibrous amniotic bands, which can result in limb or digit deformation, malformation, or autoamputation. Surgical intervention is necessary for patients with progressive or severe forms of constriction banding, but the timing and operative approach vary widely. Here, the authors present a case report detailing the successful removal of multiple congenital constriction bands (CBs), uniquely affecting the distal ankle and foot in an infant meeting Patterson type-2 criteria. This type is characterized by CBs resulting in distal deformation with or without swelling. In this case, urgent intervention was prompted by concerns of vascular compromise, and amputation was considered due to the severity of the banding. However, the authors advocated for a staged approach, with the aim of preserving the patient's limb. A series of three separate procedures tailored to the patient's banding pattern and subsequent tissue complications were required to achieve restoration of ankle and foot functions, as well as satisfactory cosmesis. This case report underscores the importance of a customized surgical approach in addressing complex CBs and emphasizes the need for proactive consideration of salvage interventions by surgeons.

Fig. 1.

Initial presentation on day 1 of life demonstrating a large, multilobulated mass on the dorsum of the foot with two amniotic constrictions bands located more proximally at the ankle.

Fig. 2.

Intraoperative view demonstrating effective decompression of the distal ankle after removal of two full-thickness CBs.

Fig. 3.

Six weeks postoperative visit after the second decompression surgery where the constriction band overlying the dorsum of the foot was successfully removed.

Fig. 4.

Two months postoperative after the third and final procedure during which excessive skin was resected.