Fetal surgery of extremity amniotic bands: an experimental model of in utero limb salvage in fetal lamb.

Abstract

BACKGROUND:

Extremity amniotic band (EAB) syndrome can cause an intrauterine amputation as a result of a mechanical effect with progressive strangulation. The aim of the study is to assess the use of fetal surgery of EABs with risk of amputation in the ovine fetus.

METHODS:

Right limbs of fifteen 60-day-gestational age fetal sheep were ligated with silk suture at the infracondylar level. Left limbs were used for paired comparison. Fetuses were randomized into 3 groups: an early-repair group (n = 5), a late-repair group (n = 5), and a nonrepaired group (n = 5). The limbs of the 2 repaired groups underwent fetal release. The limbs obtained from at-term fetuses were analyzed morphologically, functionally, and radiologically. Statistical analysis with paired test was used to compare data.

RESULTS:

Nonrepaired limbs showed amputation or quasi amputation; the repaired ones did not. However, those late-repaired had significantly reduced passive ankle range of motion, shorter limb length, and mild residual changes.

CONCLUSIONS:

Intrauterine release of potentially severe EABs prevents limb amputation and leads to morphofunctional recovery. Early release shows better results.

CLINICAL RELEVANCE:

: Intrauterine amputations caused by EABs in the human fetus might be avoidable by fetal surgery.

• Authors: Francisco Soldado, Marius Aguirre, Jose L Peiró, Cesar G Fontecha, Marielle Esteves, Roberto Velez, Vicenç Martínez-Ibáñez
• Journal: Journal of pediatric orthopedics (J Pediatr Orthop) 2009 Jan-Feb Vol. 29 Issue 1 Pg. 98-102 ISSN: 1539-2570 [Electronic] United States
• PMID: 19098655 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Amniotic Band Syndrome (surgery)
• Amputation, Traumatic (prevention & control)
• Animals
• Ankle Joint (pathology, surgery)
• Data Interpretation, Statistical
• Disease Models, Animal
• Extremities (embryology, pathology, surgery)
• Female
• Fetus
• Humans
• Infant, Newborn
• Leg Length Inequality (etiology)
• Limb Salvage (methods)
• Pregnancy
• Random Allocation
• Range of Motion, Articular
• Sheep
• Time Factors
• Treatment Outcome