Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz

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Gasparella, P; Flucher, C; Beqo, BP; Schmidt, B; Spendel, S; Arneitz, C; Till, H; Haxhija, EQ; Singer, G.
Outcome after Surgical Treatment of Venous Malformations of the Hand in Childhood.
J Vasc Surg Venous Lymphat Disord. 2023; Doi: 10.1016/j.jvsv.2023.02.004
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Führende Autor*innen der Med Uni Graz
Gasparella Paolo
Haxhija Emir
Co-Autor*innen der Med Uni Graz
Arneitz Christoph
Beqo Besiana
Flucher Christina
Schmidt Barbara
Singer Georg
Spendel Stephan
Till Holger

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INTRODUCTION: Surgical treatment of venous malformations (VMs) of the hand is challenging. The hand´s small functional units, dense innervation, and terminal vasculature can be easily compromised during invasive interventions like surgery or sclerotherapy, leading to an increased risk of functional impairment, cosmetic consequences, and negative psychological effects. METHODS: We have conducted a retrospective review of all surgically treated patients diagnosed with VMs of the hand between 2000 to 2019 and evaluated their symptoms, diagnostic investigations, complications, and recurrences. RESULTS: Twenty-nine patients (females=15) with a median age of 9.9 years (range 0.6-18) were included. Eleven patients presented with VMs involving at least one of the fingers. In 16 patients, the palm and/or dorsum of the hand was affected. Two children presented with multifocal lesions. All patients presented with swelling. Preoperative imaging was done in 26 patients and consisted of MRI in 9 patients, ultrasound in 8 patients and both modalities in 9 patients. Three patients underwent surgical resection of the lesions without any imaging. Indications for surgery were pain and restriction of function (n=16), and when lesions were preoperatively evaluated as completely resectable (n=11). In 17 patients, a complete surgical resection of the VMs was performed, while in 12 children an incomplete resection of VM was deemed due to nerve sheath infiltration. At a median follow up of 135 months (IQR 136.5, range 36-253 months), recurrence occurred in 11 (37.9%) patients after a median time of 22 months (range 2-36). Eight patients (27.6%) were reoperated because of pain, while 3 patients were treated conservatively. The rate of recurrences did not significantly differ between patients presenting with (n=7 out of 12) or without (n=4 out of 17) local nerve infiltration (p=0.119). All surgically treated patients who were diagnosed without preoperative imaging developed a relapse. DISCUSSION: VMs in the region of the hand are difficult to treat and surgery is associated with a high recurrence rate. Accurate diagnostic imaging and meticulous surgery may contribute to improve the outcome of the patients.

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