Amniotic Band Syndrome: Head-to-Toe Manifestations and Clinical Management Guidelines

Abstract

Learning Objectives: After studying this article, the participant should be able to: 1. Understand and describe the basic principles underlying the intrinsic versus extrinsic proposed mechanisms for the development of amniotic band syndrome (ABS). 2. Discuss risk factors and conditions that are associated with the development of ABS. 3. Understand the various presentations and associated clinical implications of ABS by anatomic location. 4. Describe the basic tenets underlying various repair technique options for ABS of the extremities. 5. Discuss the common manifestations of ABS in the face and trunk. 6. Understand clinical implications of fetoscopic surgery as it relates to ABS treatment as a novel method for limb salvage in utero. Summary: Amniotic band syndrome (ABS) refers to the development of constrictive bands of fibrotic tissue in utero. It can lead to a variety of clinical manifestations after delivery. There is much debate in the plastic surgery community regarding the exact pathophysiologic mechanism for the development of ABS, and the most appropriate management. This CME article aims to provide an overview of ABS manifestations throughout the body, and to expound on the most recent advances in anticipatory and definitive management of the condition.

Common Pediatric Hand Anomalies

“…92 Inglesby's review of ABS cites a 0 to 33% recurrence rate of amniotic bands with recurrence attributed to incomplete resection of the band at the time of reconstruction. 93…”

Keystone Flap in Amniotic Band Syndrome—Innovative Approach of an Established Operative Technique for an Unusual Entity

“…In cases where constrictive amniotic rings or associated defects are detected, surgical repair is recommended. Immediate treatment is necessary in the case of vascular compression or all-layered tissue necrosis and constriction rings [21]. Additionally, prompt intervention is warranted if signs of nerve compression emerge within the initial week of life, as early treatment has been shown to enhance the potential for functional recovery [22].…”

“…While the etiology of ABS is not yet fully understood, it is known that the anatomy proximal to a constriction ring remains preservable and recoverable. Hence, it is one of the guidelines for reconstructive surgeons to restore form and function [21]. Therefore, reconstructive strategies have been developed over time, which meet the following criteria: (1) providing similar tissue in terms of function, color, texture, and sensitivity; (2) causing no or minimal functional or aesthetic morbidity of donor areas; (3) being versatile for any reconstructive requirement; (4) requiring short operation durations; and (5) being replicable with quick learning curves.…”

“…The flap is then unfolded either from the upper aspect or the lower aspect of the defect, effectively serving as a turnover flap to fill the dead space. Modifications of the original technique by Mutaf and Suny have been described by Inglesby et al executing the release and turnover of the subcutaneous fat without the inclusion of the overlying dermis [21]. Retaining a segment of the subcutaneous tissue along with the undermined dermis is believed to safeguard extra volume and blood supply for the incised skin edges.…”