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Case Reports
. 2017 Apr;7(2):e74-e78.
doi: 10.1055/s-0037-1602125.

Salvage of Necrotic-Appearing Limb after In Utero Endoscopic Lysis of Constriction Bands

M Abdel-Sattar  1 , A Chon  1 , B Chen  2 , W Burkhalter  3 , R H Chmait  1
Affiliations
Case Reports

Salvage of Necrotic-Appearing Limb after In Utero Endoscopic Lysis of Constriction Bands

M Abdel-Sattar et al. AJP Rep. 2017 Apr.

Abstract

We report a case of amniotic band syndrome complicated by constriction bands and marked distal swelling of both lower extremities. Color Doppler interrogation of the right lower extremity revealed complete lack of blood flow below the level of the constriction. Upon fetoscopic survey, the right lower extremity beyond the constriction band appeared dusky red and discolored with desquamation, consistent with a necrotic appearance. The constriction bands were cut in utero using endoshears, thereby allowing restoration of blood flow on postoperative day 1. The patient was counseled extensively regarding the possibility of limb dysfunction or amputation. However, the baby was born with functional lower extremities, and at 21 months of age, the child was cruising and jumping on his own. This case demonstrates that there is unique plasticity in fetal limb recovery after a severe ischemic injury that is not otherwise seen in postnatal life. Reperfusion of the necrotic-appearing limb resulted in restoration of appearance and function without apparent deleterious effects on the fetus. We believe the favorable outcome in this case was likely due to timeliness of the in utero lysis of amniotic bands and the plasticity of fetal healing.

Keywords: amniotic band syndrome; constriction band; fetoscopy; reperfusion.

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Figures

Fig. 1
Fig. 1
Preoperative ultrasound images of the right and left lower extremities. (a) Right leg with no evidence of color Doppler waveforms distal to the constriction bands. (b) Color Doppler waveforms present along the entire length of the left lower extremity (bracket).
Fig. 2
Fig. 2
Fetoscopic view at 22 weeks' gestational age. (a) Constriction band on the lower right extremity. (b) Right lower extremity appeared dusky red with desquamation distal to the constriction band.
Fig. 3
Fig. 3
Postoperative ultrasound images of the right lower extremity demonstrating both arterial (a) and venous (b) color Doppler waveforms distal to the constriction site.
Fig. 4
Fig. 4
Lower extremities at 21 months of life. (a) Anterior view. (b) Posterior view.
See this image and copyright information in PMC

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