A New Technique for Correction of Congenital Constriction Rings

Abstract

Congenital constriction ring (CCR) is among the most common congenital anomaly of the extremities. However, few techniques have been described for correction of this anomaly, and none of these techniques could provide a complete elimination of the deformity. Therefore, new surgical techniques are needed for correction of this challenging deformity. Here, a new technique, namely, Mutaf procedure, for the correction of congenital constriction rings is described. In this technique, following excision of the fibrotic constriction ring, the groove is filled with the turnover dermofat flaps elevated from both sides of the ring in an alternating pattern. Then skin closure is done with rectangular-plasty technique. Over 8 years, this new technique was used for correction of severe CCRs of the lower extremities in 7 patients aged 1-7 years. In all patients, a normal extremity contour was obtained, with complete elimination of the sandglass deformity caused by the constriction ring. A mean follow-up of 3 years revealed a normal growth of the operated extremity in all patients. The scars were found to be esthetically acceptable. No further surgery was required. Filling the circular groove caused by the constriction ring with dermofat flaps, this new technique eliminates the soft tissue deficiency and provides a normal extremity contour. Moreover, since rectangular-plasty allows replacing the major limbs of the incisional scars within the relaxed skin tension lines, it provides a better scar in comparison with old Z-plasty techniques.