Surgical treatment of venous malformation and misciagnosed superficial vascular anomalies

Kim, Jeong Tae; Kim, Seok Kwun

Abstract

We can classify the vasular anomalies into hemangiomas and vascular malformations in accordance with Mulliken's classification. But most surgeons and physicians have not yet been used to these terminologies and so incoherent terms have frequently caused problematic confusion in the interdepartment discussion, many trial and errors and uncontrollable patients' distrust with the waste of time in spite of various kinds of therapeutic practices. It is primarily important that the selection of therapeutic methods must be decided, assuming the usage of an accurate diagnosis and academic terms. The differntial diagnosis between hemangiomas and superficial vascular malfomations (capillary or venous malformations) is especially bewared and then the surgical resection is always considered as a method of treatment modalities, especially at any time whenever other practices end in failure or ineffective. Sometimes, patient's descriptions and clinical features of lesions during follow up periods are more helpful in the diagnosis of lesions than other studies especially in long-term or recurred, complicated vascular lesions. In primay venous malformations, we have tried surgical resections and in recurred cases radical resection and immediate reconstruction with normally vascularized flap have been applied. Such normally vascularized island and free flaps can prevent the postoperative ischemic bed from stimulating the dormant or inactivated shunts and causing new pathologic potentials of recurrence. Over a 2-year period, 16 patients underwent surgery. Of the 16 patients, 8 superficial vascular anomalies had previous malpractices such as inappropriate laser therapy or steroid. They had all surgical resection and reconstructive procedure if needed. The another 8 patients of venous malformations involving the face, neck and hand had radical resection and reconstruction with a normally vascularized island or free flap for prevention of recurrence. The mean follow-up period was 11 months and no recurrence was observed.