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

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.