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Surgical Management of Vascular Malformations of the Upper Extremity: A 12-Year Retrospective Cohort Study
Sophia Hu1, Tessa E Muss1, Yoshiko Toyoda1
1From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
Insights
Surgical excision is a safe and effective treatment for pediatric upper extremity vascular malformations (VMs), with most lesions fully resolved after one procedure. This approach offers good outcomes for improving function and aesthetics.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Dermatology
Background:
- Vascular malformations (VMs) are congenital anomalies that vary in vessel type and tissue involvement.
- Upper extremity (UE) VMs present unique functional and aesthetic challenges in children.
- Advances in nonoperative and operative techniques necessitate a review of surgical management for UE VMs.
Purpose of the Study:
- To review the surgical management of pediatric upper extremity vascular malformations.
- To evaluate the safety, efficacy, and outcomes of surgical excision for UE VMs.
- To identify factors influencing treatment success and complication rates.
Main Methods:
- Retrospective review of patients undergoing surgical management for VMs from 2010-2021.
- Data collected included demographics, lesion characteristics, treatments, complications, and outcomes.
- Operative details such as excision depth and closure type were analyzed.
Main Results:
- Eighty-eight procedures were performed on 67 pediatric patients with UE VMs.
- Venous and lymphatic malformations were most common, frequently located on the hand and forearm.
- Sixty percent of patients achieved complete lesion resolution after a single surgical procedure with low complication rates.
Conclusions:
- Surgical excision is a safe and effective primary treatment for pediatric UE VMs.
- Most VMs can be completely excised in one procedure with primarily closed incisions.
- Further research should explore optimal decision-making across all VM treatment modalities for UE.
Introduction:
Vascular malformations (VMs) typically appear at birth and grow commensurately with patients. They can vary broadly in vessel type and tissue involvement, and upper extremity (UE) VMs can pose unique functional and aesthetic challenges in children. Given the advent of operative and nonoperative technologies like sclerotherapy and medications, a contemporary review of the surgical management of UE VMs is warranted.
Methods:
We performed a retrospective review of all patients who had surgical management of VMs from 2010 to 2021 at The Children's Hospital of Philadelphia. Demographics, lesion characteristics, treatment (including preceding nonsurgical therapies), complications, and final outcomes were recorded. Operative notes were reviewed for date of operation, depth of excision, type of closure, and current procedural terminology code.
Results:
Sixty-seven patients with 88 procedures were studied. Average patient age was 5.8 years, with 64% White and 67% male. Venous (34%) and lymphatic (19%) malformations were most common, and anatomic locations were most frequently on the hand (33%) and forearm (25%). The average lesion diameter was 4.2 cm, although this varied by location (eg, 2.9 cm, hand; 11.1 cm, chest wall). Fifty-eight patients (87%) underwent surgical excision as their index procedure, and 9 had sclerotherapy before surgery. Thirty-nine patients (60%) had subcutaneous excisions, and the remainder required subfascial or intramuscular excisions. Nearly all excisions were closed primarily (97%). Of the 53 patients with documented follow-up, 32 patients (60%) had complete resolution of their lesion as of their final visit. Thirty of these 32 patients with no clinical evidence of residual VM had only 1 surgery for excision.
Conclusion:
Upper extremity VMs were composed of diverse conditions with varying vessel types, size, depth, and anatomic sites. Surgical excision of VMs of the UE was safe and effective. A majority of VMs were fully excised after 1 procedure and frequently closed primarily with relatively low complication rates. Future work should investigate decision-making and outcomes of all treatment options of VMs of the UE for optimal functionality and aesthetics.
