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


CONCLUSIONS
: Intrauterine amputations caused by EABs in the human fetus might be avoidable by fetal surgery.
Soldado
Francisco
F
Paediatric Orthopaedic Surgery Unit, Department of Orthopaedic Surgery, Universidad Autónoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 34194fsc@comb.es
Aguirre
Marius
M
Peiró
Jose L
JL
Fontecha
Cesar G
CG
Esteves
Marielle
M
Velez
Roberto
R
Martínez-Ibáñez
Vicenç
V
D000652:Amniotic Band Syndrome / Q000601:surgery*; D000673:Amputation, Traumatic / Q000517:prevention & control*; D000818:Animals; D000843:Ankle Joint / Q000473:pathology / Q000601:surgery; D003627:Data Interpretation, Statistical; D004195:Disease Models, Animal; D005121:Extremities / Q000196:embryology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005333:Fetus; D006801:Humans; D007231:Infant, Newborn; D007870:Leg Length Inequality / Q000209:etiology; D023821:Limb Salvage / Q000379:methods*; D011247:Pregnancy; D011897:Random Allocation; D016059:Range of Motion, Articular; D012756:Sheep; D013997:Time Factors; D016896:Treatment Outcome