Chapter 172 - Congenital vascular malformations surgical management Flashcards
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Congenital lipomatous overgrowth vascular malformation epidermal nevi and skeletal abnormalities syndrome
Vascular tumors
1) infantile hemangioma
2) kaposiform hemangioendothelioma
3) tufted angioma
mTOR inhibitors
mammalian target of rapamycin
Treatment of capillary malformation
1) flashlamp pulse-dye laser therapy
2) debulking
Lymphatic malformation classification
Macrocystic >1cm
Microcystic < 1cm
Combination of both
Symptoms of lymphatic malformation
Difficulty swallowing/breathing
Cutaneous black vesicles leaking serosanguinous fluid
Infection
Change with illnesses
Principles of lymphatic malformation surgical excision
1) lenticular excision
2) remove skin to prevent future rupture of lymphatic cutaneous vesicles
3) looks like fat but feels different
4) intraoperative nerve stimuli to ensure nerve protected
5) remove as much as possible in first surgery due to difficulty of reoperation
Principles of lymphatic malformation excision in abdomen/pelvis
1) sclerotherapy for macrocystic lesion
2) observe microcystic lesions
3) bowel resection if causing pain and obstruction
4) splenectomy if hypersplenism or splenomegaly and symptomatic
Lymphatic malformation in thorax treatment
1) chemical or mechanical pleurodesis
2) pericardial window or pericardiocentesis
3) octreotide, low fat diet, TPN
4) ligation of thoracic duct (can worsen symptoms)
5) shunts
Post-operative drain duration in lymphatic malformation surgery
long time up to months
Until < 10-15ml/day
Venous malformation of GI tract key points
1) mouth to anus
2) Blue rubber bleb nevus syndrome (BRBNS)
3) intersussception
4) avoid constipation - bleed (stoll softener)
5) bowel obstruction
Venous malformation surgical excision key points
1) tourniquet use
2) remove excess skin
3) BRBNS: wedbe bowel resection, band ligation, polypectomy, suture-ligation
4) IMV can be ectatic causing stagnation of blood –> portomesenteric thrombosis (treat by ligation)
Symptoms of AVM
1) pink stain
2) expand during hormonal change or trauma
3) skin ischemia/steal, pain, ulceration
4) nerve compression
5) tissue destruction
6) bleeding
7) high output cardiac failure
Surgical management of AVM
1) embolization of nidus
2) surgical resection in 2-3 days since reexpansion can occur with longer wait
3) leave feeding artery alone unless the entire AVM is removed
Use of frozen sections in AVM surgery
no use
