Summary
The management of vascular anomalies in upper and lower limbs is complex. The current
practice at Birmingham Children's Hospital is based on a multidisciplinary approach,
involving plastic surgeons, interventional radiologists, vascular surgeons, dermatologists
and laser specialists. This study reviews the management strategies for peripheral
venous malformations (VMs) and proposes a simple classification system to aid treatment.
A retrospective review was undertaken involving all paediatric patients presenting
with (VMs) of the upper and lower limbs, managed by the same multidisciplinary team
over a period of 3 years. A total of 33 patients were identified, of whom 19 had lesions
located in the upper limb. Treatment modalities included surgery, sclerotherapy, a
combination of the two and conservative management. The indications for treatment
included: (1) worsening pain, (2) increased swelling, (3) reduced function, (4) bleeding
or ulceration and finally, (5) cosmetic deformity. Following treatment, outcome measures
with regards to the symptoms were graded into (1) improved, (2) worsened and (3) unchanged.
Based on magnetic resonance imaging, we were able to apply our classification to separate
the lesions into Type 1a (superficial localised): nine, Type 1b (superficial diffused):
five, Type 2 (Fascia/muscle infiltration): nine, Type 3 (Bone/joint infiltration):
seven and Type 4 (Extensive whole-limb infiltration): three.
In patients with upper limb VMs (n=19), eight lesions (42%) were superficial and localised (Type 1a) while the rest were
diffused lesions. In contrast, in the lower limb (n=14), only one lesion (7%) was superficial while the rest were diffused lesions. Lower
success rate for treatment was noted in lower limb malformations (p<0.05). In eight patients with recurrence of symptoms, six had Type 3 (intra-articular)
lesions. There was one major and three minor complications following treatment.
An outline of the management strategies for VMs in peripheral limbs is discussed in
this article. An anatomical classification is described which aids in management and
communication.
Keywords
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Article info
Publication history
Published online: December 29, 2008
Accepted:
November 8,
2008
Received:
August 5,
2008
Identification
Copyright
© 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
