Advances in Fetal Surgery: Current and Future Relevance in Plastic Surgery

Abstract

Scarless healing has long been the holy grail for plastic surgery. While historically fetal surgery has tempted plastic surgeons with the allure of scarless correction of congenital abnormalities, the risks far outweighed the benefits and these interventions never materialized. Current advances in fetal surgery with minimally invasive fetoscopic surgery have made these early fetal interventions safer, leading to expanding applications. While the plastic surgeon's role is limited as of yet, this article provides a review of the history of fetal surgery and the advances that may become relevant to the future plastic surgeon.

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

“…50 These interventions are usually performed at 18 to 28 weeks’ gestational age and typically result in significantly reduced scar burden compared with procedures performed postnatally because of differences in dermal remodeling for scar healing in the fetal wound environment. 50,51…”

“…Although diagnosis of ABS in utero has rarely prompted intervention before birth, in utero intervention has become a topic of discussion in the plastic surgery community over the past decade. [49][50][51][52][53][54] Although typically performed by obstetric and pediatric surgeons currently, the topic has become more frequently discussed in the literature as a treatment modality for which plastic surgery involvement may become more prominent. 50 Open hysterotomy surgery, first performed in 1981, 50 has been used for serious malformations, and amniotic bands have been released with lasers or scissors for umbilical cord strangulation and threatened limb compromise through this open approach.…”

“…When compared with the traditional open hysterotomy approach, these fetoscopic cases are thought to decrease risk for uterine dehiscence and eliminate the need for a cesarian section. 50 These interventions are usually performed at 18 to 28 weeks' gestational age and typically result in significantly reduced scar burden compared with procedures performed postnatally because of differences in dermal remodeling for scar healing in the fetal wound environment. 50,51 Proposed indication includes compromised blood flow to the umbilical cord or an extremity, whereas advanced or irreversible distal extremity damage (eg, fracture, amputation, lack of Doppler flow) is considered a relative contraindication.…”

Prenatal Diagnosis of Pseudoamniotic Band Syndrome following Laser Coagulation of Placental Anastomoses

“…Выжидательная позиция с тщательным наблюдением за внутриутробным состоянием плода целесообразна, если нет угрозы внутриутробной гибели или ампутации конечностей. Хирургическая внутриутробная помощь актуальна, когда отмечается снижение интенсивности кровотока при допплеровских измерениях дистальнее зоны сжатия псевдоамниотическим тяжем и появляется отек конечности [17,18].…”

Teenage Pregnancy with Chorioangioma: A Case Report with a Review on the Recent Trends on its Diagnosis and Management

“…Risk factors for chorioangioma include increased maternal age, first pregnancy, female fetus, high-altitude, essential hypertension and multifetal gestation [1,2,12]. Diagnosis is usually by ultrasound between 23-35 weeks of gestation and confirmed by histopathology [13][14][15]. Early diagnosis is preponderant as an increase in their size is an indication of potential complications.…”