Release of amniotic bands/constriction bands

Paediatric pre-operative/post-operative day surgery patients

What are amniotic bands/constriction bands?

Amniotic/constriction bands form while your child is still in the womb. They occur when fibrous bands in the amnionic sac get tangled around the developing foetus, affecting the growth to that area of the body, due to restricted blood flow. They can cause symptoms that range from a small band around a limb to more serious problems such as part of the limb being missing.

Why release amniotic/constriction bands from limbs?

Amniotic/constriction bands are released to help with limb swelling and to prevent any further damage. Rarely they are released on an emergency basis to improve blood flow. If the amniotic/constriction band goes all the way around a limb, it is normally released in stages.

Before the operation

Your child will be seen in clinic by a consultant plastic surgeon, and your child will be added to a waiting list at this point. Photographs are normally taken during the appointment.

You will receive a telephone call or letter to offer you a date and time to come in for your child’s surgery. You will also have an appointment at the children’s pre-operative assessment clinic to check your child is well for the procedure and to order further tests if needed or to refer to an anaesthetist.

Please make sure that you have a supply of paracetamol and ibuprofen (if your child can take these) at home to give after the operation.

If your child is unwell from the time of being listed for surgery, please contact the admissions team to inform them, as the surgery may need to be postponed due to the increased risk of anaesthetic.

On the day of surgery

When your child arrives on the ward

Please arrive on the ward at the correct date and time of admission of your child’s planned surgery. Please make sure that fasting (not eating or drinking) instructions have been followed: if these have not been followed the procedure may not go ahead.

The time of admission is not the time that your child will go down to theatre. The order of the operating list is organised by children’s age and clinical need.

A nurse will admit your child to the ward. Admission includes:

• Checking your child’s details
• Recording any allergies and taking your child’s temperature
• Pulse and blood pressure readings.

Depending on your child’s age, numbing cream may be applied to their hands, if they are going to be asleep during the operation.

You will see the surgical team who will gain written permission (consent) from you to say you are happy for the procedure to go ahead. Before signing the consent form the surgical team will discuss what the procedure will include and the risks and benefits of carrying out the surgery. You can also ask any questions that you may have about the procedure. They will also mark the area to be operated on with a surgical marker pen.

The anaesthetist will also see your child before to going to theatre. They will check your child is medically fit for the procedure and general anaesthetic (if your child is having this). They will also discuss the different ways that the anaesthetic can be given, and which method would be best for your child.

Your child will change into a gown ready to go down to the operating theatre.

You can accompany your child to the anaesthetic room and stay while your child goes to sleep. You will not be able to accompany your child into the operating theatre. A member of staff will take you through to the recovery room where staff will take a contact number to call you on to inform you that your child is in recovery.

In theatre

If your child did not have a cannula inserted in their hand in the anaesthetic room due to the method used to give anaesthetic before going to sleep, they will have one inserted once they are asleep. A cannula enables medications to be given during the operation, and after surgery if required.

Once your child is asleep, local anaesthetic is injected into the area to be operated on. This will help to make your child more comfortable after the operation.

The surgeon will cut along the part of the skin that the band is affecting to release it. The skin will be stitched back together in a zigzag pattern (Z plasty); this is to help elongate the scar and to reduce the chance of the scar contracting. The stitches are normally dissolvable, so they do not need removing - they will come out on their own. A non-adhesive dressing is then applied with a bandage over the top.

After the operation

You will be contacted by recovery when your child is starting to wake up.

After the surgery your child may feel drowsy or sleepy. They may be restless and upset after waking from surgery (this normally settles on its own).

Your child can eat and drink as soon as they feel able to after the procedure.

Your child will have a bandage on the affected limb.

You may go home once your child has eaten, drunk and passed urine. We will also make sure that your child is comfortable after the procedure, before they go home.

After you go home

Paracetamol and ibuprofen should be given regularly for the first couple of days.

The dressing will need to be kept dry.

Keep the limb raised as much as possible. This will reduce swelling to the limb and can reduce pain.

It is normal for there to be some oozing from the wound after surgery. If, when you are back at home, there is fresh blood visible please contact the children’s plastic surgery CNS or attend A&E.

You will normally have an appointment to come back to the children’s dressing clinic one to two weeks after surgery, for a wound check and dressing change if required. It is normal for the stitch line to contain dried blood along it; this will eventually come off with washing or as the stitches start to come out.

Once the stitches come out, the scar should be moisturised and massaged with a simple unperfumed moisturiser a minimum of twice a day.

Your child will have a follow-up appointment with the consultant.

Signs of infection

• Redness around the wound or spreading away from the wound.
• Increased pain to the wound that is out of proportion to the surgery carried out.
• The wound is hot to touch, when compared with the temperature of the surrounding skin.
• There is a foul smell coming from the wound.
• There is pus or excessive ooze from the wound.
• Your child has a temperature and feels unwell

If any of these signs appear please contact your GP, but if your child is very ill taking them straight to A&E.

Medication

Bring all your child’s medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Please tell the ward staff about all the medicines your child uses. During your stay if you wish to give your child’s medication to them, please speak with your nurse before. Pharmacists visit the wards regularly and can help with any medicine queries.

MyChart

We would encourage you to sign up for MyChart on behalf of your child. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.

If you are interested in this please let us know and we can provide information, or look on our website: MyChart

Contacts/further information

Paediatric Plastic Surgery CNS: 07729107964

Email paediatric plastics team