From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine; and Division of Plastic Surgery, Texas Children's Hospital.
Plast Reconstr Surg. 2022 Nov 1;150(5):1059-1069. doi: 10.1097/PRS.0000000000009651. Epub 2022 Aug 24.
Arteriovenous malformations are abnormal high-flow vascular anomalies that can greatly alter the structure of surrounding tissues. Treatment of symptomatic hand arteriovenous malformations must address the functional and aesthetic considerations of the hand. Nonsurgical treatment such as embolization continues to be plagued by complications such as digital ischemia and secondary need for amputation. In this study, the authors describe their experience treating hand arteriovenous malformations with wide resection and microsurgical reconstruction of the palmar arch. This technique aims to optimize postoperative function and minimize postoperative complications and recurrence.
Retrospective review identified five patients who underwent surgical excision of hand arteriovenous malformations performed by two of the senior authors (W.C.P. and M.M.) between 2002 and 2020. Four patients underwent reconstruction of the palmar arch, whereas one patient underwent ray amputation of the involved index finger only. One patient required concurrent free flap for soft-tissue coverage following resection.
Mean age at the time of surgery was 34.6 years. After an average follow-up of 2.7 years, there were no postoperative complications, functional deficits, or recurrences. The patient who underwent ray amputation only was postoperatively noted to have pulsatile dorsal veins concerning for a persistent high-flow state, although no recurrent mass was seen at limited 1-year follow-up.
Meticulous surgical excision with microvascular reconstruction is an acceptable technique for management of symptomatic hand arteriovenous malformations. Potential soft-tissue loss does not preclude aggressive resection. Wide excision with palmar arch reconstruction minimizes complications, optimizes functionality, and may prevent ischemia that could otherwise trigger recurrence.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
动静脉畸形是一种异常的高流量血管畸形，可极大地改变周围组织的结构。治疗有症状的手部动静脉畸形必须考虑到手的功能和美观因素。非手术治疗，如栓塞，仍然受到诸如指端缺血和继发性需要截肢等并发症的困扰。在这项研究中，作者描述了他们用广泛切除和掌弓显微重建治疗手部动静脉畸形的经验。该技术旨在优化术后功能，最大限度地减少术后并发症和复发。
回顾性研究确定了 5 名患者，他们在 2002 年至 2020 年间由两位资深作者（W.C.P.和 M.M.）进行了手部动静脉畸形的手术切除。4 例患者行掌弓重建，1 例患者仅行受累食指的射线截断。1 例患者在切除后需要同时进行游离皮瓣用于软组织覆盖。
手术时的平均年龄为 34.6 岁。平均随访 2.7 年后，无术后并发症、功能缺陷或复发。仅行射线截断的患者术后出现搏动性背侧静脉，提示存在持续的高流量状态，但在有限的 1 年随访中未见复发病灶。
显微血管重建的精细手术切除是治疗有症状的手部动静脉畸形的一种可接受的技术。潜在的软组织丢失并不排除积极的切除。掌弓重建的广泛切除可减少并发症，优化功能，并可能防止缺血，否则可能引发复发。
临床问题/证据水平：治疗，IV。
