Abstract Sagittal craniosynostosis is the most common non-syndromic single-suture synostosis, resulting in a restricted, elongated calvarial vault clinically known as scaphocephaly. If left untreated, this mechanical restriction can lead to elevated intracranial pressure and subsequent neurocognitive impairment. Spring-assisted cranioplasty (SAC) has emerged as a safe, minimally invasive surgical alternative to traditional open calvarial vault remodeling (CVR) and endoscopic strip craniectomy (ESC). This procedure combines a targeted osteotomy with the continuous outward distraction of internal metal springs to expand the intracranial space and normalize cranial morphology. SAC is best performed in infants before 6 months, with the springs typically removed 3 to 4 months postimplantation once complete calvarial reossification is radiographically confirmed. Clinical outcomes demonstrate that SAC achieves lasting improvements in the cephalic index comparable to CVR, while significantly reducing intraoperative blood loss, operative duration, intensive care unit utilization, and overall hospital costs. Furthermore, SAC eliminates the extensive, months-long orthotic helmet compliance mandated by ESC, establishing it as a highly effective intervention for appropriately selected infants.
The development of the upper extremity begins early in embryogenesis, with the upper extremity fully formed by week 8 of gestation. This process relies on a complex cascade of molecular interactions-a single abnormality of which can result in congenital anomalies. Hand surgeons have the opportunity to significantly improve the quality of life of patients with congenital anomalies and require a thorough understanding of the underlying embryological processes resulting in these anomalies. This chapter provides an overview of the stages of upper extremity development, the molecular mechanisms of upper extremity embryogenesis, and the congenital anomalies that can result from abnormalities of various stages of this process.
Constriction band syndrome is a rare congenital deformity that occurs in 0.5 to 1.1 per 10,000 births and presents as a range of malformations from constriction bands to autoamputation. The etiology of constriction band syndrome is incompletely understood, but the leading theory suggests that partial rupture of the inner amnion prior to fusion with the outer chorion creates fibrous chorionic bands that constrict fetal parts. Given the heterogeneity of malformations, a comprehensive physical examination is essential for accurate diagnosis. Depending on the severity of the constriction band, surgical intervention can range from simple excision of constriction bands to on-top-plasties in cases of digit deficiencies. Importantly, each patient should receive an individualized approach based on their anatomy, which considers the urgency of constriction band release, preservation of the neurovascular structures, viability of the distal body part, and maximization of functionality. With these goals in mind, surgical management of constriction band syndrome regardless of presentation can greatly improve function and cosmesis in affected children.
