Surgery Of Venous Malformation--New Strategies
MCKAY MCKINNON, MD1, RAMSEN AZIZI, MD2, NGUYEN HONG HA, MD3, NGUYEN QUANG DAI, MD4.
1LURIE CHILDREN’S HOSPITAL, CHICAGO, IL, USA, 2ST. JOSEPH'S HOSPITAL, CHICAGO, IL, USA, 3VIETDUC HOSPITAL, HANOI, Viet Nam, 4FRENCH VIETNAM HOSPITAL, HO CHI MINH CITY, Viet Nam.
Surgery of Venous Malformations_New Strategies
Purpose: Enormous controversies continue regarding correct treatment of venous malformation (VM), including time and type of intervention. The morbidity and mortality of VMs remain a serious threat to patients. Treatment of VM by a variety of specialists has led to conflicting opinions and, we suggest, increased morbidity. There is a clear need for consensus based upon evidence of superior treatment outcomes. This study examines the results of surgery on the postulation that it represents the most effective treatment for permanent control and/or cure of VM.
Material and Methods: This study represents the surgical experience of one plastic surgeon with 20 craniofacial venous malformations, including the largest facial VM reported. Pre-operative physical examinations, MRI and CT findings, photographs and Doppler examinations are presented as are long-term post-operative results, recurrences and complications.
Results: All patients were followed up for at least one year. There were no deaths from surgery or other treatments. No patients were successfully treated except by surgery. Successful treatment (no residual tumor or no significant residual tumor) was achieved by surgery in 19 of 20 patients. Conclusions: (1) Radical excisional surgery can be a primary curative therapy with minimal morbidity for VM; (2) Sclerotherapy, alcohol injection, embolisation and laser therapy should not be the primary mode of therapy for large, high flow VMs; (3) Vascular surgical techniques can render large VMs manageable and insignificant; and (4) The ultimate goal of treatment should be complete or near-complete excision of VMs.
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