Streeter's Syndrome, also known as amniotic band syndrome, occurs when different parts of the body in utero get partially or completely wrapped up in the amniotic membrane. This can lead to a wide variety of musculoskeletal pathology, for example, an amniotic band can lead to an amputation of a limb in utero. The patient would be born without a segment of a limb. This is called a transverse amputation since the amputation occurs completely across the segment such as across the mid humerus, forearm, thigh, or leg and in these cases one would be missing the upper or lower extremity respectively.
More commonly, we see amniotic bands creating constriction bands around parts of the skeleton. This can occur anywhere including the head, neck and torso but most commonly around parts of the extremities. Since the more peripheral extremities are in closer contact with the amniotic membrane, fingers and toes are the most commonly affected; therefore amniotic bands around the fingers and toes lead to partial amputations of one or more fingers and toes and fusion of the skin between fingers and toes leading to syndactyly.
Because the resistance of these constriction bands is a significant counter to growth, they often lead to a variety of growth related deformities such as bony deformities, joint contractures, club feet, etc. Therefore the presentation after the child is born can be quite variable. We have frequently seen patients come in with severe knee flexion contractures and an amniotic band around the thigh. The amniotic bands lead to problems of development of the muscles underlying the band and damage to the underlying nerves and blood vessels. As such, a band around the thigh may eliminate the muscles underneath the band such as the quadriceps and hamstring muscles. Obviously, some circulation must be getting through for the limb to be viable. Therefore, the vessels are often constricted under the band and this creates a need for decompression of these vessels and/or nerves. The feet of legs with significant constriction bands are often insensate since the nerves have been completely damaged by the band. This becomes a significant consideration whether the limb should be reconstructed versus amputated. When the limb is completely insensate, frequent pressure sores and skin breakdown can occur.
At the Paley Institute, we have treated the full spectrum of the sequelae of Streeter's Syndrome (amniotic band syndrome). We have treated the problems ranging from constriction bands at different levels requiring releases, club feet requiring correction, knee contractures requiring straightening, and leg length discrepancy requiring equalization.
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