Introduction: Amniotic constriction band (ACB) refers to congenital abnormalities characterized by the entanglement of fibrous strand of inner amniotic layer around the fetus. The clinical manifestations of ACB vary based on the affected site. Significant malformations include finger or toe syndactyly or amputations, cleft lip and palate, clubbed foot, or fetal death. Peripheral nerve palsy is a rare complication of ACB.
Methods: A systematic review of the literature was performed in accordance with the PRISMA guidelines to identify cases describing peripheral nerve palsy due to ACB (1986-2024). PubMed, SCOPUS, and EMBASE databases were searched using the search terms “amniotic band” AND “peripheral nerve”. Variables recorded include, nerve affected, location, symptoms, surgical intervention type, early/late intervention (late = > 1 month post-diagnosis), follow-up, and demographic characteristics. The outcome was measured as complete recovery/partial improvement/no improvement. Furthermore, we present the case of a neonate with distal brachial constriction band causing hand drop, with a 12 yearlong follow-up.
Results: The initial search identified 80 studies. 14 articles were included, with a total of 18 patients. The mean age at presentation was 10.2 years, with a range of 7 days-54 years. 72.2% of patients were male, and 27.8% female. The ulnar nerve was affected in 72.2% cases, radial in 44.4%, and median in 22.2%, common perineal in 5.6%, and sciatic nerve in 5.6% of cases.
Treatment included neurolysis in 50% of cases, Z-plasties in 55.6% of cases, and nerve grafting in 16.7% of cases. 61.1% underwent early intervention,, whereas 38.9% late intervention. 44.4% of patients achieved complete recovery , 27.8% partial improvement, and 27.8% had no improvement. Among early intervention cases, 45.5% achieved complete recovery, 36.4% had partial improvement and 18.2% showed no improvement. Among late intervention cases, 42.9% achieved complete recovery, 14.3% partial improvement and 42.9% had no improvement.
Conclusion : Timely diagnosis and early surgical intervention are essential in facilitating nerve recovery and improving functional outcomes.
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