背景:血管畸形(VM)通常在出生时出现,并与患者相应地生长。它们在血管类型和组织受累方面可以有很大差异,和上肢(UE)虚拟机可能对儿童构成独特的功能和美学挑战。鉴于硬化疗法和药物等手术和非手术技术的出现,有必要对UEVM的手术管理进行当代审查.
方法:我们对2010年至2021年在费城儿童医院接受VM手术治疗的所有患者进行了回顾性研究。人口统计,病变特征,治疗(包括之前的非手术疗法),并发症,并记录最终结果.审查了操作说明的操作日期,切除深度,闭合类型,和当前的程序术语代码。
结果:研究了67例88例手术患者。患者平均年龄为5.8岁,64%的白人和67%的男性。静脉畸形(34%)和淋巴管畸形(19%)最为常见,解剖位置最常见的是手部(33%)和前臂(25%)。平均病灶直径4.2cm,尽管这因位置而异(例如,2.9cm,手;11.1厘米,胸壁)。58名患者(87%)接受了手术切除作为他们的指标程序,9人在手术前接受了硬化治疗。39例患者(60%)进行了皮下切除,其余的需要筋膜下或肌肉内切除。几乎所有切除手术都是关闭的(97%)。在有记录的随访的53名患者中,32名患者(60%)在最后一次就诊时已完全解决病变。在这32例没有临床证据的患者中,有30例仅进行了1次切除手术。
结论:上肢VM由不同血管类型的不同条件组成,尺寸,深度,和解剖部位。手术切除UE的VM是安全有效的。大多数VM在1次手术后被完全切除,并且经常闭合,主要并发症发生率相对较低。未来的工作应该调查UE的VM的所有治疗选项的决策和结果,以获得最佳的功能和美观性。
BACKGROUND: 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.
CONCLUSIONS: 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.