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Fetal Surgery of Extremity Amniotic Bands: An Experimental Model of In Utero Limb Salvage in Fetal Lamb

Soldado, Francisco MD*; Aguirre, Marius PhD*; Peiró, Jose L. PhD; Fontecha, Cesar G. PhD*; Esteves, Marielle MD; Velez, Roberto MD*; Martínez-Ibáñez, Vicenç PhD

doi: 10.1097/BPO.0b013e318192196e
Selected Topics: Original Article

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.

Level of Evidence: Level of evidence II.

From the *Paediatric Orthopaedic Surgery Unit, Department of Orthopaedic Surgery, †Fetal Surgery Unit, Department of Pediatric Surgery, and ‡Veterinarian Unit, Research Institute, Universidad Autónoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain.

This study was conducted at the Universitat Auto˘noma de Barcelona, Institut de Recerca Hospital Universitari Vall d'Hebron.

This study was supported by grants from the Spanish Health Ministry FIS PI040512, Fundació Ferrer Investigació, and Fundació Privada A. Bosch.

Reprints: Francisco Soldado, MD, Universitat Autònoma de Barcelona, Area Maternoinfantil, Hospital Universitari Vall d'Hebron, Passeig Vall D'Hebron 119-129, Barcelona 08035. E-mail

© 2009 Lippincott Williams & Wilkins, Inc.