Congenital band syndrome, also known as Streeter syndrome, results from traumatic fetal injury caused by remnants of ruptured amniotic membranes that constrict developing tissues in the womb. It can cause syndactyly or webbing of the fingers and toes as well as deeper constrictions of the limbs. Reconstruction often requires z-plasties to improve contour and release of bands, with clefts sometimes complicating web space reconstruction. Associations may include prenatal conditions like oligohydramnios. Patterson classification categorizes the severity of banding. Treatment options include fetoscopic band release or later reconstruction surgery.

1. CONGENITAL BAND SYNDROME/
STREETER SYNDROME
 Syndactyly seen in congenital band
syndrome should be named as
acrosyndactyly because the condition results
from the traumatic fetal injury and doesn’t
represent failure of formation as other
syndactylies do.

2. Deep constriction seen in the region of junction of middle
and distal thirds of calf

3. Early separation of
fingertips
Don’t lose
hope

4. On top plasty
Resection of indexed metacarpal creates a
deeper web space , and the island pedicle
tissue transferred to lengthen the thumb to
sensate and vascularized.

5. Patterson type 3
Acrosyndactyly in band
syndrome
Presence of clefts / fistulae is the
distinguishing feature of
acrosyndactyly in band syndrome
These clefts are the result of
distal fusion of the healing fetal
skin after the intrauterine injury.
Cotton tipped applicator sticks
pass through the sinus tracts
left over from the base of
former web.

6. These clefts are distal to the normal web
level, this can complicate the design of
dorsal flap for reconstruction of a normal
web more proximally.

8. Z PLASTY
This child had a deep band
just above the elbow,
along with complete
median and ulnar nerve
palsy. A z plasty improved
the cosmetic defect, but
paralysis persisted.

9. High median and ulnar nerve
palsy
Hand with a high mdian and
ulnar nerve palsy , severe
thenar atrophy and supinated
position of the thumb can be
seen .

10. Deep cleft on the
distal end of the tibia
Marked bowing of
tibia
After band
reconstruction,
tibia and soft
tissues improved

11. Band revision for more
prox clefts gives an
improved contour, once
the scars mature , they are
cosmetically acceptable.

12. Type 2 band with
deformity distal to the
band
Amputation of
the tip of the ring
finger is a type 4
band.
Type 1 band with no
deformity is present
in the midportion of
long finger

13. Simple release of the tip of index finger and thumb in this 4 month
old child doesn’t require grafting and improved use of digits, laterat
2-4 yrs of age, more formal reconstruction of thumb-index web may
be required.

14. See the digits amputated in
both differently
symbrachydactyly Congenital band
syndrome

15. Z plasty in the skin is
opposite the one in deeper
tissues
2 layer closure of upton on the more proximal bands
of the limb.

16. Associations of congenital
band syndrome

17. history
 Prenatal history – oligohydramnios,
premature uterine contractions, leakage of
fluid.

18. Other names
 Streeter syndrome/ dysplasia
 Annular bands
 Grooves / rings
 Constriction ring syndrome
 Congenital band syndrome
 Amniotic band syndrome
 Amniotic disruption sequence

19. Patterson classification for
banding
 Type 1 – simple constriction ring
 Type2 – constriction ring with deformity of
the distal part
 Type 3 – constriction with fusion of distal
parts
 Type 4 – complete intrauterine amputation.

20. TREATMENT
 Fetoscopic release of an amniotic band.

21. Best to delay z plasty until the digits size and
skin healing are more favourable.

22. Two layer closure is preferable in areas with enough of
the subcutaneous layer present, on the digits this is
usually not practical , and here we use a single layer
closure