Keystone Flap in Amniotic Band Syndrome—Innovative Approach of an Established Operative Technique for an Unusual Entity
Abstract
:1. Introduction
2. Surgical Strategy
2.1. Operative Technique
2.2. Operative Timing
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Montgomery, W.F. Observations on the spontaneous amputation of the limbs of the fœtus in Utero, with an attempt to explain the occasional causes of its production. Dublin J. Med. Chem. Sci. 1832, 1, 140–144. [Google Scholar] [CrossRef]
- Goldfarb, C.A.; Sathienkijkanchai, A.; Robin, N.H. Amniotic constriction band: A multidisciplinary assessment of etiology and clinical presentation. J. Bone Jt. Surg. Am. 2009, 91 (Suppl. S4), 68–75. [Google Scholar] [CrossRef]
- Muraskas, J.K.; McDonnell, J.F.; Chudik, R.J.; Salyer, K.E.; Glynn, L. Amniotic band syndrome with significant orofacial clefts and disruptions and distortions of craniofacial structures. J. Pediatr. Surg. 2003, 38, 635–638. [Google Scholar] [CrossRef]
- Capone, A.C.; Balasundaram, N.; Caouette-Laberge, L.; Papay, F.A.; Lucas, A.R.; Seifarth, F.G.; Doumit, G.D. Novel techniques for the surgical management of abdominopelvic constriction rings in amniotic band syndrome. Plast. Reconstr. Surg. 2015, 135, 563–568. [Google Scholar] [CrossRef] [PubMed]
- Chiu, D.T.W.; Patel, A.; Sakamoto, S.; Chu, A. The Impact of Microsurgery on Congenital Hand Anomalies Associated with Amniotic Band Syndrome. Plast. Reconstr. Surg. Glob. Open 2018, 6, e1657. [Google Scholar] [CrossRef] [PubMed]
- Rayan, G.M. Amniotic constriction band. J. Hand Surg. Am. 2002, 27, 1110–1111. [Google Scholar] [CrossRef] [PubMed]
- Streeter, G.L. Focal Deficiency in Fetal Tissues and Their Relation to Intrauterine Amputation. Contrib. Embryol. 1930, 33, 41–49. [Google Scholar]
- Moerman, P.; Fryns, J.P.; Vandenberghe, K.; Lauweryns, J.M. Constrictive amniotic bands, amniotic adhesions, and limb-body wall complex: Discrete disruption sequences with pathogenetic overlap. Am. J. Med. Genet. 1992, 42, 470–479. [Google Scholar] [CrossRef]
- Robin, N.H.; Franklin, J.; Prucka, S.; Ryan, A.B.; Grant, J.H. Clefting, amniotic bands, and polydactyly: A distinct phenotype that supports an intrinsic mechanism for amniotic band sequence. Am. J. Med. Genet. A 2005, 137A, 298–301. [Google Scholar] [CrossRef]
- Gandhi, M.; Rac, M.W.F.; McKinney, J. Medicine SfM-F. Amniotic Band Sequence. Am. J. Obstet. Gynecol. 2019, 221, B5–B6. [Google Scholar] [CrossRef]
- Wiedrich, T.A. Congenital constriction band syndrome. Hand Clin. 1998, 14, 29–38. [Google Scholar] [CrossRef] [PubMed]
- Moran, S.L.; Jensen, M.; Bravo, C. Amniotic band syndrome of the upper extremity: Diagnosis and management. J. Am. Acad. Orthop. Surg. 2007, 15, 397–407. [Google Scholar] [CrossRef] [PubMed]
- Behan, F.C. The Keystone Design Perforator Island Flap in reconstructive surgery. ANZ J. Surg. 2003, 73, 112–120. [Google Scholar] [CrossRef]
- Khouri, J.S.; Egeland, B.M.; Daily, S.D.; Harake, M.S.; Kwon, S.; Neligan, P.C.; Kuzon, W.M., Jr. The keystone island flap: Use in large defects of the trunk and extremities in soft-tissue reconstruction. Plast. Reconstr. Surg. 2011, 127, 1212–1221. [Google Scholar] [CrossRef] [PubMed]
- Behan, F.C.; Rozen, W.M.; Kapila, S.; Ng, S.K. Two for the price of one: A keystone design equals two conjoined V-Y flaps. ANZ J. Surg. 2011, 81, 405–406. [Google Scholar] [CrossRef] [PubMed]
- Pauchot, J.; Chambert, J.; Remache, D.; Elkhyat, A.; Jacquet, E. Geometrical analysis of the V-Y advancement flap applied to a keystone flap. J. Plast. Reconstr. Aesthet. Surg. 2012, 65, 1087–1095. [Google Scholar] [CrossRef] [PubMed]
- Mohan, A.T.; Rammos, C.K.; Akhavan, A.A.; Martinez, J.; Wu, P.S.; Moran, S.L.; Sim, F.H.; Behan, F.; Mardini, S.; Saint-Cyr, M. Evolving Concepts of Keystone Perforator Island Flaps (KPIF): Principles of Perforator Anatomy, Design Modifications, and Extended Clinical Applications. Plast. Reconstr. Surg. 2016, 137, 1909–1920. [Google Scholar] [CrossRef] [PubMed]
- Saint-Cyr, M.; Wong, C.; Schaverien, M.; Mojallal, A.; Rohrich, R.J. The perforasome theory: Vascular anatomy and clinical implications. Plast. Reconstr. Surg. 2009, 124, 1529–1544. [Google Scholar] [CrossRef]
- Behan, F.C.; Lo, C.H.; Findlay, M. Anatomical basis for the keystone island flap in the upper thigh. Plast. Reconstr. Surg. 2010, 125, 421–423. [Google Scholar] [CrossRef]
- Pelissier, P.; Gardet, H.; Pinsolle, V.; Santoul, M.; Behan, F.C. The keystone design perforator island flap. Part II: Clinical applications. J. Plast. Reconstr. Aesthet. Surg. 2007, 60, 888–891. [Google Scholar] [CrossRef]
- Inglesby, D.C.; Janssen, P.L.; Graziano, F.D.; Gopman, J.M.; Rutland, J.W.; Taub, P.J. Amniotic Band Syndrome: Head-to-Toe Manifestations and Clinical Management Guidelines. Plast. Reconstr. Surg. 2023, 152, 338e–346e. [Google Scholar] [PubMed]
- Mohan, A.S.; Russo, S.A.; Pet, M.A. Early Surgical Intervention in Amniotic Band Sequence for Upper Extremity Motor Nerve Palsies: A Case Report. Hand 2022, 17, NP5–NP11. [Google Scholar] [CrossRef] [PubMed]
- Weinzweig, N.; Barr, A. Radial, ulnar, and median nerve palsies caused by a congenital constriction band of the arm: Single-stage correction. Plast. Reconstr. Surg. 1994, 94, 872–876. [Google Scholar] [CrossRef] [PubMed]
- Dufournier, B.; Guero, S.; de Tienda, M.; Dana, C.; Garcelon, N.; Glorion, C.; Salon, A.; Pannier, S. One-stage circumferential limb ring constriction release and direct circular skin closure in amniotic band syndrome: A 14-case series. Orthop. Traumatol. Surg. Res. OTSR 2020, 106, 1353–1359. [Google Scholar] [CrossRef] [PubMed]
- Patterson, T.J. Congenital ring-constrictions. Br. J. Plast. Surg. 1961, 14, 1–31. [Google Scholar] [CrossRef] [PubMed]
- Mutschall, H.; Winkler, S.; Weisbach, V.; Arkudas, A.; Horch, R.E.; Steiner, D. Bone tissue engineering using adipose-derived stem cells and endothelial cells: Effects of the cell ratio. J. Cell. Mol. Med. 2020, 24, 7034–7043. [Google Scholar] [CrossRef] [PubMed]
- Heltmann-Meyer, S.; Steiner, D.; Muller, C.; Schneidereit, D.; Friedrich, O.; Salehi, S.; Engel, F.B.; Arkudas, A.; Horch, R.E. Gelatin methacryloyl is a slow degrading material allowing vascularization and long-term usein vivo. Biomed. Mater. 2021, 16, 065004. [Google Scholar] [CrossRef] [PubMed]
- Bigdeli, A.K.; Didzun, O.; Thomas, B.; Harhaus, L.; Gazyakan, E.; Horch, R.E.; Kneser, U. Combined versus Single Perforator Propeller Flaps for Reconstruction of Large Soft Tissue Defects: A Retrospective Clinical Study. J. Pers. Med. 2022, 12, 41. [Google Scholar] [CrossRef]
- Gomez, O.J.; Baron, O.I.; Penarredonda, M.L. Keystone Flap: Overcoming Paradigms. Plast. Reconstr. Surg. Glob. Open 2019, 7, e2126. [Google Scholar] [CrossRef]
- Lo Torto, F.; Frattaroli, J.M.; Kaciulyte, J.; Mori, F.L.R.; Troisi, L.; Ciudad, P.; Manrique, O.J.; Marcasciano, M.; Pajardi, G.E.; Casella, D.; et al. The keystone flap: A multi-centric experience in elderly patients treatment. J. Plast. Reconstr. Aesthet. Surg. 2022, 75, 226–239. [Google Scholar] [CrossRef]
- Seretis, K.; Bounas, N.; Lykoudis, E.G. Reconstruction of midline abdominal defects with a deep inferior epigastric artery keystone-type perforator flap. J. Plast. Reconstr. Aesthet. Surg. JPRAS 2022, 75, 893–939. [Google Scholar] [CrossRef] [PubMed]
- Jiang, Y.; Mao, H.; Yang, X.; Zhou, S.; Ni, F.; Xu, Q.; Wang, B. Single-Stage Resection of Type II Constriction Rings in Limbs on the Basis of Histologic and Magnetic Resonance Imaging Observations: A Retrospective Study of 21 Consecutive Patients. Plast. Reconstr. Surg. 2016, 138, 164–173. [Google Scholar] [CrossRef] [PubMed]
- Mutaf, M.; Sunay, M. A new technique for correction of congenital constriction rings. Ann. Plast. Surg. 2006, 57, 646–652. [Google Scholar] [CrossRef] [PubMed]
- Castro-Govea, Y.; Vela-Martinez, A.; Treviño-Garcia, L.A. Lipoinjection and Multiple Internal Cuts for Congenital Constriction Bands: A New Treatment Approach. Aesthet. Plast. Surg. 2017, 41, 375–380. [Google Scholar] [CrossRef] [PubMed]
- Habenicht, R.; Hülsemann, W.; Lohmeyer, J.A.; Mann, M. Ten-year experience with one-step correction of constriction rings by complete circular resection and linear circumferential skin closure. J. Plast. Reconstr. Aesthet. Surg. JPRAS 2013, 66, 1117–1122. [Google Scholar] [CrossRef] [PubMed]
- Nakajima, H.; Imanishi, N.; Fukuzumi, S.; Minabe, T.; Aiso, S.; Fujino, T. Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities: Anatomical study and a concept of the venoadipofascial and/or neuroadipofascial pedicled fasciocutaneous flap. Plast. Reconstr. Surg. 1998, 102, 779–791. [Google Scholar] [CrossRef] [PubMed]
- Chin, M.S.; Chappell, A.G.; Giatsidis, G.; Perry, D.J.; Lujan-Hernandez, J.; Haddad, A.; Matsumine, H.; Orgill, D.P.; Lalikos, J.F. Hyperspectral Imaging Provides Early Prediction of Random Axial Flap Necrosis in a Preclinical Model. Plast. Reconstr. Surg. 2017, 139, 1285e–1290e. [Google Scholar] [CrossRef] [PubMed]
- Muller-Seubert, W.; Ostermaier, P.; Horch, R.E.; Distel, L.; Frey, B.; Cai, A.; Arkudas, A. Intra- and Early Postoperative Evaluation of Malperfused Areas in an Irradiated Random Pattern Skin Flap Model Using Indocyanine Green Angiography and Near-Infrared Reflectance-Based Imaging and Infrared Thermography. J. Pers. Med. 2022, 12, 237. [Google Scholar] [CrossRef]
- Buehrer, G.; Taeger, C.D.; Ludolph, I.; Horch, R.E.; Beier, J.P. Intraoperative flap design using ICG monitoring of a conjoined fabricated anterolateral thigh/tensor fasciae latae perforator flap in a case of extensive soft tissue reconstruction at the lower extremity. Microsurgery 2016, 36, 684–688. [Google Scholar] [CrossRef]
- Schulz, T.; Marotz, J.; Stukenberg, A.; Reumuth, G.; Houschyar, K.S.; Siemers, F. Hyperspectral imaging for postoperative flap monitoring of pedicled flaps. Handchir. Mikrochir. Plast. Chir. 2020, 52, 316–324. [Google Scholar] [CrossRef]
- Pereira, N.; Hallock, G.G. Smartphone Thermography for Lower Extremity Local Flap Perforator Mapping. J. Reconstr. Microsurg. 2021, 37, 59–66. [Google Scholar] [CrossRef] [PubMed]
Localization | Defect Size [cm] | Keystone Flap Type |
---|---|---|
Right Forearm | 1 × 2 | III |
Right Forearm | 1 × 1 | IIA |
Left Forearm | 3 × 1 | IV—SMU modification |
Type | Definition |
---|---|
I | Simple ring constriction |
II | Ring constriction with presence of subcutaneous tissue defect at the level of the ring |
III | Ring constriction with any syndactyly or acrosyndactyly |
IV | Any (intrauterine) amputation |
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Promny, D.; Horch, R.E.; Promny, T. Keystone Flap in Amniotic Band Syndrome—Innovative Approach of an Established Operative Technique for an Unusual Entity. Surg. Tech. Dev. 2023, 12, 164-175. https://doi.org/10.3390/std12040016
Promny D, Horch RE, Promny T. Keystone Flap in Amniotic Band Syndrome—Innovative Approach of an Established Operative Technique for an Unusual Entity. Surgical Techniques Development. 2023; 12(4):164-175. https://doi.org/10.3390/std12040016
Chicago/Turabian StylePromny, Dominik, Raymund E. Horch, and Theresa Promny. 2023. "Keystone Flap in Amniotic Band Syndrome—Innovative Approach of an Established Operative Technique for an Unusual Entity" Surgical Techniques Development 12, no. 4: 164-175. https://doi.org/10.3390/std12040016