a 9-year - old boy presented to the outpatient department with bilateral webbing from the lateral chest wall extending up to his elbows , which looked like wings [ figure 1 ] .
this deformity had been present since birth and involved anterior axillary fold as well as medial elbow [ figure 2 ] .
this was successfully treated on the left side with multiple z - plasty operation ( parents consented for only one side initially).during the procedure , the fibrous bands were excised down to deep fascia and z - plasty flaps were transposed to lengthen the axillary and elbow contractures [ figures 3 and 4 ] .
bilateral upper limb webbing ( pterygia ) webbing involving only anterior axillary fold early post op .
it can be a part of multiple pterygium syndrome , also referred to as escobar syndrome .
it is a rare autosomal recessive disorder , which is characterized by a web across every flexion crease in the extremities , most notably the popliteal space .
in addition , this syndrome is associated with other structural anomalies : a vertical talus , vertebral segmentation anomalies and congenital lordoscoliosis .
other associated anomalies are multiple joint webs , unusual finger contractures , syndactyly , rocker bottom feet , ptosis , antimongoloid slant of palpebral fissures , epicanthal folds , cleft lip and or palate , highly arched palate , scoliosis and short stature .
autosomal recessive inheritance of multiple pterygium syndrome was suggested by findings in affected siblings with normal parents .
it is differentiated from other types of inheritance like autosomal dominant type of multiple pterygium syndrome , autosomal dominant type of popliteal pterygium syndrome and x - linked dominant inheritance variety .
pterygia seen in this variety of multiple pterygium syndrome of neck , antecubital and axillary areas are not present in the popliteal pterygium syndrome .
cleft lip ( with or without cleft palate ) has been seen in nearly all cases of popliteal pterygium syndrome , whereas cleft palate is present in only 41% of multiple pterygium syndrome .
intellect is usually normal in these cases , although there is a danger of mental retardation being assumed due to the multiple congenital defects , misdiagnosis , and delayed motor milestones .
manual dexterity is often better than predicted from the appearance of the hands as seen in our case .
correction of restricting webbing by simple z - plasty adds to the mobility of the affected limb . a joint approach with a team of paediatrician , genetics consultant and orthopaedic and plastic surgeon
 reporting images in a case of a 9-year - old boy who presented with bilateral congenital webbing ( pterygium ) of axillae and elbows . 
 this deformity was restricting his axilla and elbow movements . 
 this was successfully treated on one side with multiple z - plasty . 
 an outline of multiple pterygium syndrome is given herewith . 
CASE REPORT
DISCUSSION