Holly Brian P, Patel Yuval A, Park James, Fayad Laura M, Deune E Gene, Mitchell Sally E, Weiss Clifford R
1 The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
2 Duke University, Durham, NC, USA.
Hand (N Y). 2017 Jul;12(4):335-341. doi: 10.1177/1558944716669798. Epub 2016 Sep 16.
The standard of care for treatment of low-flow venous malformations (VMs) is percutaneous sclerotherapy. These lesions are seldom surgically resected, especially if the malformation is in an anatomically difficult location. Percutaneous sclerotherapy is safe and effective. However, the drawbacks to sclerotherapy are the need for repeated treatments and risks of skin ulceration, deep venous thrombosis, scarring/contractures, and nerve damage. Surgical resection can be difficult because of intraoperative bleeding, intraoperative lesional decompression, and difficulty in localization.
We describe our initial experience with 11 patients who underwent surgical resection of VMs located in the hand and forearm after preembolization of 27 total sites using n-butyl-cyanoacrylate or ethylene vinyl alcohol copolymer.
Of the 11 patients treated, 5 had focal VMs, 3 had multifocal VMs, and 3 had diffuse VMs throughout the affected extremity. Four of the 5 patients with focal VMs were followed for at least 1 year, and no further treatment was required. All 3 of the patients with diffuse VMs have required ongoing treatment. No major functional impairments were reported, and there were no major procedure-related complications.
Overall, embolization of the malformation before surgical resection facilitated localization, demarcation, and removal of the lesion.
低流量静脉畸形（VMs）治疗的标准护理方法是经皮硬化治疗。这些病变很少进行手术切除，特别是当畸形位于解剖学上困难的位置时。经皮硬化治疗是安全有效的。然而，硬化治疗的缺点是需要重复治疗以及存在皮肤溃疡、深静脉血栓形成、瘢痕/挛缩和神经损伤的风险。由于术中出血、术中病变减压以及定位困难，手术切除可能具有挑战性。
我们描述了11例患者的初步经验，这些患者在使用正丁基氰基丙烯酸酯或乙烯-乙烯醇共聚物对总共27个部位进行预栓塞后，接受了位于手部和前臂的VMs手术切除。
在接受治疗的11例患者中，5例为局灶性VMs，3例为多灶性VMs，3例在整个受累肢体中为弥漫性VMs。5例局灶性VMs患者中的4例随访至少1年，无需进一步治疗。所有3例弥漫性VMs患者都需要持续治疗。未报告重大功能障碍，也没有与手术相关的重大并发症。
总体而言，手术切除前对畸形进行栓塞有助于病变的定位、分界和切除。
