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.