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Hu S, Muss TE, Toyoda Y, Kim MS, Chang AE, Banala M, Graham EM, Gunturi D, Lin IC. Surgical Management of Vascular Malformations of the Upper Extremity: A 12-Year Retrospective Cohort Study. Ann Plast Surg 2024; 92:S132-S135. [PMID: 38556661 DOI: 10.1097/sap.0000000000003852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
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.
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Affiliation(s)
- Sophia Hu
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Tessa E Muss
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Yoshiko Toyoda
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Mimi S Kim
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Ashley E Chang
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Manisha Banala
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Emily M Graham
- Department of Plastic Surgery, University of Michigan, Ann Arbor, MI
| | - Deepthi Gunturi
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ines C Lin
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
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Cesar Faustino AS, Hetthessy JR. Vascular malformations and tumors of the hand: A therapeutical approach. J Orthop 2022; 34:271-275. [PMID: 36158035 PMCID: PMC9489520 DOI: 10.1016/j.jor.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/10/2022] [Accepted: 08/30/2022] [Indexed: 10/31/2022] Open
Abstract
Background Even though vascular anomalies of the hand are rare entities (7%), they are relevant regarding soft tissue mass differential diagnosis on the hand. 2 The majority of cases tend to be malformations, once denominated as deep soft tissue hemangiomas. 1 , 3 Due to evolving knowledge regarding vascular anomalies, the prognosis, guidelines regarding treatment and aftercare following therapy/surgery will be more accurate and detailed if the correct diagnosis is established. Methods Retrospective data collection and analysis between 2008 and 2019, from the Orthopedic Department of Semmelweis University tumor registry. Comparison to the current literature (PubMed, Ovid). Study level of evidence III. Standardly distributed data with confidence level of 95%. Results N = 16, average age of 34,2. 63,5% of lesions were digital. Hemangiomas accounted for 67%. The accuracy of clinical vs. histological diagnosis was 77%. Recurrences 25%. Variable follow up period. Conclusion Clinical examination, radiological evaluation, patient history and fine needle biopsy are often accurate guides. Nevertheless in our study, histological analysis of the surgical biopsy was the most effective method in establishing a definite diagnosis. Conservative and watchful waiting approach are the first line, and when complemented with appropriate imaging, should suffice until absolute or relative operative indications are present.
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van Doesburg MH, Harbech H, Lokhorst MM, Breugem CC. Surgical management of vascular malformations of the upper extremity: a review of current literature. JPRAS Open 2022; 33:63-75. [PMID: 35812353 PMCID: PMC9260259 DOI: 10.1016/j.jpra.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Vascular malformations of the upper extremity are uncommon, and there is great heterogeneity in their occurrence and appearance. There is no golden standard for the treatment of vascular malformations of the upper extremity and limited evidence on this subject has been published. Objective This review aims to answer the question whether surgical treatment leads to less recurrence and complications than non-surgical treatment for patients with vascular malformations of the upper extremity. Materials and methods A literature search in PubMed was performed up to September 2019 by using the following terms: vascular malformation, upper extremity and surgery. Inclusion criteria were: a mean follow-up duration of at least 12 months [1], outcome measurements including recurrences and/or complications [2] and the involvement of patients with vascular malformations of the upper extremity [3]. Results In total, 883 articles were found, of which seven were included in this review. A total of 358 patients were included in these studies, including 208 patients with upper extremity vascular malformations. Minor surgical complications were seen in 20% of the cases, and major complications occurred in 6%. Recurrence was reported in 32% of the cases. Conclusion Surgery for vascular malformations of the upper extremity can be a safe and effective treatment option, although some cases are better off when treated non-surgically. Literature shows various complication rates for non-surgical treatment of upper extremity vascular malformations. To determine in which case surgery is the better option, we should identify factors leading to surgical complications.
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Palmar Venous Malformation: A Case Report of a Rare Occurrence and a Treatment Algorithm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4270. [PMID: 35441065 PMCID: PMC9010119 DOI: 10.1097/gox.0000000000004270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
Palmar venous malformations are not well described in the surgical literature and are a therapeutic challenge due to the intricate anatomy of the hand. We present the case of a 19-year-old right-handed female patient from Mexico who was referred to us with a right palmar lesion present since birth, previously diagnosed as a venous malformation. The patient reported that she had undergone sclerotherapy 10 years before in addition to a prior aborted attempt at excision. Venous palmar malformations are rare occurrences. Although an individualized approach is important, the development of an algorithm may assist in the standardization of the treatment of this pathology to preserve the hand’s functional status.
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Ogur HU, Arik A, Kapi E, Cicek H, Seyfettinoglu F, Bulut M. An analysis of cases presenting with a mass in the hand and an evaluation of treatment methods. Acta Orthop Belg 2022; 88:190-197. [PMID: 35512171 DOI: 10.52628/88.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to present and discuss our clinical experience of patients presenting with a mass in the upper extremity, in respect of demographic characteristics, localisation of the mass, clinical and pathological characteristics. A retrospective evaluation was made of 114 cases (60 females, 54 males) who presented at our clinic with complaints of localised pain and swelling in the upper extremity between 1 June 2016 and 31 December 2018. The cases were separated into 3 groups; Group 1 with a mass determined in the carpal region, Group 2 with localisation between the wrist and the metacarpophalangeal joint, and Group 3, in the distal of the metacarpophalangeal joint. The mass was of soft tissue origin in 90 cases, and of bone origin in 24 cases. The distribution of cases was 6 in Group 1, 20 cases in Group 2, and 88 in Group 3. The tumour was benign in 105 (92%) cases and a primary malignancy in 9 (7.8%) cases. Recurrence occurred in 4 cases, of which 2 were enchondroma, 1 was a giant cell tendon sheath tumour, and 1 was hemangioma The majority of painful masses seen in the hand are benign and very few are malignant. In the approach to hand tumours, clinical evaluation guided by demo- graphic data, and the evaluation of diagnostic and treatment options according to the radiological ap- pearance and anatomic localisation will determine the ideal approach providing a full cure.
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Oktay BK, Kaçar AG, Özel SÇ, Ocak S, Celkan T. Clinical course of pediatric large vascular anomalies located in the extremities. Turk Arch Pediatr 2021; 56:213-218. [PMID: 34104911 DOI: 10.5152/turkarchpediatr.2021.20089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022]
Abstract
Objective Difficulties encountered in the diagnosis and treatment of vascular anomalies located in the extremities of the children. The most common vascular lesions are hemangiomas and venous malformations. The complex malformations, such as, Klippel-Trenaunay Syndrome are much less commonly encountered lesions. Treatment of vascular malformations are variable based on the etiology of the lesion and clinical presentation. In this study, we aimed to share our experience on the clinical features of vascular lesions in the extremities of the children. Material and Methods The demographic, clinical and prognostic features of 330 children with vascular anomalies followed at IUC, Cerrahpasa Medical Faculty, Department of Pediatric Hematology and Oncology were retrospectively reviewed. Fifty-one patients with lesions >5 cm in diameter were included into the study. The diagnosis, age, sex, history of prematurity, lesion type and location, imaging and biopsy findings, complications, details of treatment, and follow-up were evaluated. Results Twenty-nine (57%) of patients were female and 22 (43%) were male. The female to male ratio was 1.3:1. The median age at admission was 15 months (10 days-180 months). Eight patients (16%) had a history of premature birth. Thirty-one patients (61%) had lesions since birth, eight lesions (8%) appeared in the first month of life and 6 (12%) occurred after 1 year of age. Sixteen of the patients (31%) had hemangioma, 11 (22%) had lymphangioma, 19 (37%) had venous malformation and 5 (10%) were diagnosed as Klippel Trenaunay Syndrome. The lesions were in the upper extremity in 21 patients (41%), in the lower extremity in 27 patients (53%), and both lower and upper extremities were affected in 3 patients (6%). Of all patients, six had intramuscular and two had intraarticular lesions. The diagnosis was made on clinical grounds in most of the cases. In 22 children Magnetic Resonance Imaging was performed for differential diagnosis and to demonstrate the infrastructure of the lesion and the extent of local infiltration. Histopathologic examination by biopsy was done in four patients. Complications developed in 19 patients as follows: Disseminated intravascular coagulation in 6, bleeding in 4, thrombosis in 3, and soft tissue infection in 6. Twenty-one patients were not given any treatment. Medical treatments were propranolol in 14 patients, sirolimus in 4 patients, propranolol and sirolimus in 5 patients. Intralesional bleomycin injection was performed in 3 children. Conclusion The diagnosis, classification and treatment of extremity located vascular malformations in children are complex. Treatment strategy should be defined as in accordance with a combination of the type of the vascular malformation, the age of the patient and the clinical picture.
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Affiliation(s)
- Burcu Kılınç Oktay
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Ayşe Gonca Kaçar
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Simge Çınar Özel
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Süheyla Ocak
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Tiraje Celkan
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
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Boriani F, Raposio E, Errani C. Imaging Features of Primary Tumors of the Hand. Curr Med Imaging 2021; 17:179-196. [PMID: 32811403 DOI: 10.2174/1573405616999200817173154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
Musculoskeletal tumors of the hand are a rare entity and are divided into skeletal and soft tissue tumors. Either category comprises benign and malignant or even intermediate tumors. Basic radiology allows an optimal resolution of bone and related soft tissue areas, ultrasound and more sophisticated radiologic tools such as scintigraphy, CT and MRI allow a more accurate evaluation of tumor extent. Enchondroma is the most common benign tumor affecting bone, whereas chondrosarcoma is the most commonly represented malignant neoplasm localized to hand bones. In the soft tissues, ganglions are the most common benign tumors and epithelioid sarcoma is the most frequently represented malignant tumor targeting hand soft tissues. The knowledge regarding diagnostic and therapeutic management of these tumors is often deriving from small case series, retrospective studies or even case reports. Evidences from prospective studies or controlled trials are limited and for this lack of clear and supported evidences, data from the medical literature on the topic are controversial, in terms of demographics, clinical presentation, diagnosis, prognosis and therapy. The correct recognition of the specific subtype and extension of the tumor through first line and second line radiology is essential for the surgeon, in order to effectively direct the therapeutic decisions.
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Affiliation(s)
- Filippo Boriani
- Department of Plastic and Hand Surgery, Sanremo Hospital, Sanremo, Italy
| | - Edoardo Raposio
- Department of Surgical Sciences and Integrated Methodologies (DISC), University of Genova, Genova, Italy
| | - Costantino Errani
- Department of Musculo-Skeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Akkus G, Karagun B, Çetinalp NE, Açıkalın A, Evran M, Sengöz S, Sert M, Zorludemir S, Tetiker T. Clinical Relevance and Immunohistochemical Patterns of Silent Pituitary Adenomas: 10 Years of Single-centre Experience. Curr Med Imaging 2021; 17:310-317. [PMID: 33357196 DOI: 10.2174/1573405616666201223125642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Silent pituitary adenomas are clinically non-functional (i.e., without clinically evident pituitary hormone production). INTRODUCTION The aim of this study was to investigate subjects with silent pituitary adenomas for possible variations in their clinical status. METHODS A total of 102 patients who had undergone surgery for pituitary adenoma and had been diagnosed with silent pituitary adenoma was included in the study. The patients' preoperative and postoperative hormonal parameters and magnetic resonance imaging (MRI) features were collected, and pathological specimens were re-evaluated. RESULTS Immunohistochemistry results of the 102 patients were as follows: hormone-negative adenomas (n=35) 35.5%; FSH+LH-positivity (n=32) 31.3%; ACTH-positivity (n=11) 10.7%; α-subunit- positivity (n= 9) 8.8%; prolactin-positivity (n=8) 7.8%; GH-positivity (n=6) 5.4%; and plurihormonal adenoma (n=1). The mean sizes of SGA, SGHA, and SCA were 28.0±12.7, 30.0±16.0, and 27.7±8.9mm (p>0.05), respectively. With the exception of silent gonadotroph adenomas (SGAs), female gender dominance was shown in patients with silent growth hormone adenoma (SGHA) and silent corticotroph adenoma (SCA). Although no clinical relevance was observed in relation to hormonal excess, preoperative GH (4.21±4.6, vs. 0.27±0.36 p=0.00) was slightly more elevated in SGHA than in GH-negative adenomas. Additionally, preoperative basal ACTH values (47.3±28.7 vs. 23.9±14.4, p=0.003) were also higher in SCA compared to the other types. Our findings revealed SCAs to be of more aggressive behaviour than SGHAs and SGAs due to invasiveness in radiological imaging, their elevated re-operation, and postoperative ACTH values. CONCLUSION Silent pituitary adenomas represent a challenging diagnostic tumour group. Careful initial evaluation of patients with pituitary adenomas should consider any mild signs and symptoms of functionality, particularly in cases of GH- and ACTH-secreting adenomas.
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Affiliation(s)
- Gamze Akkus
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Barış Karagun
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Nuri E Çetinalp
- Cukurova University, Faculty of Medicine, Division of Neurosurgery, Adana, Turkey
| | - Arbil Açıkalın
- Cukurova University, Faculty of Medicine, Divison of Pathology, Adana, Turkey
| | - Mehtap Evran
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Sinem Sengöz
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Murat Sert
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Suzan Zorludemir
- Cukurova University, Faculty of Medicine, Divison of Pathology, Adana, Turkey
| | - Tamer Tetiker
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
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Banegas-Ruiz R, Román-Hernández R, Gómez-Mendoza FF, Mendoza-Aceves RA, Baca-Domínguez CR, Caprielova YJ, Pérez-Ortega E, Torres J, Valderrama-Treviño AI. Use of anterolateral thigh free flap for reconstruction and salvage of thoracic limb caused by an arteriovenous malformation. Ann R Coll Surg Engl 2021; 103:e173-e176. [PMID: 33682460 DOI: 10.1308/rcsann.2020.7119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Vascular arteriovenous malformations originate during the early stages of embryonic development and generally grow progressively, especially during adolescence and pregnancy. Limb salvage using microsurgery is presented, in a patient with an arteriovenous malformation who was initially a candidate for limb amputation. En bloc resection of the arteriovenous malformation of all segments with extended brachial approach and the cutaneous component was performed, with an anterolateral thigh free flap for the lateral reconstruction of the hand.
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Affiliation(s)
- R Banegas-Ruiz
- Rehabilitation Hospital, Luis Guillermo Ibarra Ibarra, CDMX, Mexico
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10
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Karunaratne YG, Greer D, Hong LH, Somia N, Wargon O, Adams S. Low-flow vascular malformations of the hand and forearm: a multidisciplinary experience in a tertiary paediatric centre. ANZ J Surg 2021; 91:1739-1743. [PMID: 33475243 DOI: 10.1111/ans.16591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/30/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vascular malformations (VMs) involving the hand and forearm in children provide management challenges due to complex anatomy, indispensable functionality and developmental implications. METHODS The institution's Vascular Registry was searched for patients with hand and arm VMs, supplemented by chart review of included patients. RESULTS Twenty-one patients were identified, 52% male, with mean presenting age 5.2 years. Venous malformations predominated (71%), followed by lymphatic-venous (19%), lymphatic (5%) and glomuvenous (5%). Symptoms included pain (76%), swelling (71%), cosmetic concerns (81%), functional compromise (29%) and stiffness (5%). Imaging modality was ultrasound (100%), and magnetic resonance imaging (71%). Treatment included compression (62%), sclerotherapy (62%) and surgery (24%). Post-sclerotherapy ultrasounds showed complete sclerosis (25%), near complete sclerosis (58%) and partial sclerosis (17%). Post-surgery, patients reported improved cosmesis (80%), size (100%), pain (60%) and function (40%). Complications occurred in 24%, including bleeding, digital ischaemia and thrombosis. Mean follow-up was 3.4 years. CONCLUSION Children with low-flow VMs of the hand and forearm experience significant symptoms and functional limitations. A multidisciplinary approach to management ensures optimal outcomes.
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Affiliation(s)
- Yasiru G Karunaratne
- Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
- Department of Plastic and Reconstructive Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Douglas Greer
- Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Ling H Hong
- School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Naveen Somia
- Department of Plastic and Reconstructive Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Orli Wargon
- School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Dermatology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Susan Adams
- Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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ACR Appropriateness Criteria® Clinically Suspected Vascular Malformation of the Extremities. J Am Coll Radiol 2019; 16:S340-S347. [DOI: 10.1016/j.jacr.2019.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/21/2022]
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12
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Nepal P, Songmen S, Alam SI, Gandhi D, Ghimire N, Ojili V. Common Soft Tissue Tumors Involving the Hand with Histopathological Correlation. J Clin Imaging Sci 2019; 9:15. [PMID: 31448166 PMCID: PMC6702939 DOI: 10.25259/jcis-6-2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/16/2019] [Indexed: 01/14/2023] Open
Abstract
Soft tissue tumors involving the hand are common and most often benign. It is important to know the spectrum of soft tissue tumors of the hand and understand the typical as well as atypical imaging features are seen on different imaging modalities. The imaging features are largely determined by the tumor histopathology; thus, the basic idea about the tumor histopathology will always be useful. This article intends to focus on a comprehensive approach including demographics, clinical presentation, and imaging findings required to diagnose the tumor definitely or narrow the differentials. This article discusses common soft tissue tumor mimics of the hand as well, however, excludes the bone tumors for the sake of brevity.
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Affiliation(s)
- Pankaj Nepal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | | | | | - Darshan Gandhi
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Neeta Ghimire
- Department of Pediatric Dentistry, Kathmandu University, Nepal
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA
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Abstract
Vascular anomalies are common in the upper extremities, but there continues to be a relative paucity of information about them in publications dealing with surgery in the hands and upper limbs. The wide spectrum of pathology and an inconsistent use of terminology make vascular anomalies susceptible to incorrect diagnosis and as a result, to misdirected management. This article aims to provide an update on vascular anomalies relevant to the upper limbs, focusing on significant advances in pathogenesis and genetics, classification systems, diagnosis and treatment.
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Affiliation(s)
- Konrad Mende
- 1 Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland.,3 Department of Hand, Plastic and Reconstructive Surgeon, Great Ormond Street Hospital, London, UK
| | - Neil Vargesson
- 2 School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Branavan Sivakumar
- 3 Department of Hand, Plastic and Reconstructive Surgeon, Great Ormond Street Hospital, London, UK
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14
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Kota AA, Hazra D, Selvaraj AD. Basilic vein haemangioma: an unusual differential diagnosis for cubital fossa mass. BMJ Case Rep 2018; 2018:bcr-2015-211343. [PMID: 29599380 DOI: 10.1136/bcr-2015-211343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Subcutaneous masses along the cubital fossa can be a diagnostic dilemma. Most patients are asymptomatic and usually present for a cosmetic reason. Diagnosis can be confirmed by radiological findings and histopathology. We present a case report of a similar mass that turned out to be a haemangioma arising from the basilic vein with brief review of literature.
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Affiliation(s)
- Albert Abhinay Kota
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Darpa Hazra
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Andrew Dheepak Selvaraj
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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15
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Sherman CE, Murray PM. Tumor-Like Conditions of the Hand and Upper Extremity. J Hand Surg Am 2017; 42:1009-1017. [PMID: 29089162 DOI: 10.1016/j.jhsa.2017.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/18/2017] [Indexed: 02/02/2023]
Abstract
Tumor-like conditions of the hand and upper extremity typically present as masses and can be confused as more serious conditions. The differential diagnosis of these lesions can cross over with many more commonly recognized benign and malignant upper limb tumors, and it is, therefore, important for the hand surgeon to be familiar with tumor-like conditions. The diagnosis of these lesions often can be made on clinical grounds supported by a careful physical examination and plain film radiography. Advanced imaging and excisional biopsy may be needed in many circumstances to secure the diagnosis given their similarity with bone and soft tissue sarcomas.
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Affiliation(s)
| | - Peter M Murray
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL.
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16
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Page F, Harb A, Titley G. Ischaemic peripheral polyneuropathy in the upper limb as a result of steal phenomenon in an arteriovenous malformation. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Karcich JS, Parcells AL, Datiashvili RO. Not your typical angioma. EPLASTY 2015; 15:ic3. [PMID: 25671054 PMCID: PMC4294178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Jenika S. Karcich
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School Newark, NJ
| | - Alexis L. Parcells
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School Newark, NJ,Correspondence:
| | - Ramazi O. Datiashvili
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School Newark, NJ
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Lee KW, Lee HI, Kim CH, Kim TK. Large Cavernous Hemangioma of the Subscapularis Muscle - A Case Report. Clin Shoulder Elb 2014. [DOI: 10.5397/cise.2014.17.4.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Weitz NA, Bayer ML, Baselga E, Torres M, Siegel D, Drolet BA, Frieden IJ, Haggstrom AN. The “biker-glove” pattern of segmental infantile hemangiomas on the hands and feet. J Am Acad Dermatol 2014; 71:542-7. [DOI: 10.1016/j.jaad.2014.04.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 04/24/2014] [Accepted: 04/27/2014] [Indexed: 11/30/2022]
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Hatanaka M, Nakazawa A, Nakano N, Matsuoka K, Ikeda H, Hamano I, Sakamoto S, Kasahara M. Successful living donor liver transplantation for giant extensive venous malformation. Pediatr Transplant 2014; 18:E152-6. [PMID: 24815871 DOI: 10.1111/petr.12280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 01/27/2023]
Abstract
We report our success in employing LDLT as a course of treatment for extensive hepatic VM. A 14-yr-old pediatric patient presented at our hospital with nosebleed, fatigability, orthopnea, and abdominal distension. He had a history of right hemicolectomy with primary anastomosis due to VM of the transverse colon at age seven. Coagulation abnormalities were apparent, characterized by high international normalized ratio of prothrombin time, decreased fibrinogen level, increased FDPs, and D-dimer. T2-weighted magnetic resonance imaging revealed numerous, variable-sized high signal intensity nodules. Abdominal ultrasonography and CT scan showed hepatomegaly with multiple hypo-echogenic lesions and arteriovenous shunting in the liver. Doppler ultrasound showed hypokinetic flow in the hypo-echogenic lesions of liver. Immediate LDLT was performed to avoid spontaneous rupture and DIC. The right lobe of the liver was implanted with temporary portocaval shunt to prevent intestinal congestion and bleeding. Pathologic examination of the explanted liver confirmed the presence of an extensive hepatic VM. The postoperative course was uneventful, and the patient remained symptom-free with normal liver function throughout the 12-month follow-up period.
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Affiliation(s)
- Masahiro Hatanaka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatric Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
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Abstract
Vascular malformations of the hand and wrist are uncommon. They develop from aberrations in angiogenic signaling during vascular development. Unlike hemangiomas, which are characterized by biphasic growth and slow spontaneous involution, vascular malformations continue to grow proportionally with the child. Management is dictated by classification of the vascular malformations, which is based on flow characteristics (ie, low, high) and predominant cell type (ie, venous, lymphatic, capillary, combined, arteriovenous). Initial management is conservative, with the goal of providing relief from pain and swelling. Sclerotherapy, laser treatment, and arterial embolization may be beneficial in well-selected patients. Surgery is indicated in cases of persistent pain and uncontrolled limb swelling leading to functional impairment and/or neurologic compression. The goals of surgery are to excise as much of the lesion as possible while avoiding injury to adjacent nerves, minimizing blood loss, and preventing distal limb ischemia. This mandates careful preoperative planning and meticulous technique. Adjuvant treatments may be warranted, as in the case of preoperative embolization in patients with high-flow lesions.
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Ferkel EI, Speer AL, Anselmo D, Panossian A, Stanley P, Arkader A. Vascular Malformations and Associated Syndromes: The Role of the Orthopaedic Surgeon. JBJS Rev 2014; 2:01874474-201405000-00002. [PMID: 27500606 DOI: 10.2106/jbjs.rvw.m.00075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Eric I Ferkel
- Department of Orthopaedic Surgery, The Keck School of Medicine of the University of Southern California, 1200 North State Street, GNH-3900, Los Angeles, CA 90033
| | - Allison L Speer
- Department of General Surgery, The Keck School of Medicine of the University of Southern California, 1520 San Pablo Street, Suite 4300, Los Angeles, CA 90033
| | - Dean Anselmo
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #100, Los Angeles, CA 90027
| | - Andre Panossian
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #96, Los Angeles, CA 90027
| | - Philip Stanley
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #81, Los Angeles, CA 90027
| | - Alexandre Arkader
- Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #69, Los Angeles, California, 90027
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Freshwater MF. Treatment of vascular anomalies of the upper extremity. J Hand Surg Am 2011; 36:370. [PMID: 21276909 DOI: 10.1016/j.jhsa.2010.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 11/14/2010] [Indexed: 02/02/2023]
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