Vascular malformations of the upper limb: A review of 270 patients
Identifieur interne : 00AC30 ( Main/Exploration ); précédent : 00AC29; suivant : 00AC31Vascular malformations of the upper limb: A review of 270 patients
Auteurs : Joseph Upton [États-Unis] ; Christopher J. Coombs [États-Unis] ; John B. Mulliken [États-Unis] ; Patricia E. Burrows [États-Unis] ; Stephen Pap [États-Unis]Source :
- Journal of Hand Surgery [ 0363-5023 ] ; 1999.
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Abstract
Vascular malformations of the upper limb were once thought to be impossible to properly diagnose and treat. We reviewed our experience with these malformations of the upper limb in 270 patients seen over a 28-year period. These anomalies were slightly more common in females than males (ratio, 1.5:1.0). The malformations were categorized as either slow flow (venous, n = 125; lymphatic, n = 47; capillary, n = 32; combined, n = 33) or fast flow (arterial, n = 33). Three categories of fast-flow malformations were identified and designated as types A, B, and C. Over 90% of these lesions could be properly diagnosed by their appearance and growth pattern within the first 2 years of life. Additional radiographic studies were used to confirm this diagnosis and to define specific characteristics. Magnetic resonance imaging with and without contrast best demonstrated site, size, flow characteristics, and involvement of contiguous structures for all types of malformations. Algorithms for treatment of both slow-flow and fast-flow anomalies are presented. Two hundred sixty surgical resections were performed in 141 patients, including 24 of 33 fast-flow anomalies. Preoperative angiographic assessment, with magnified views, was an important preoperative adjunct before any well-planned resection of fast-flow arteriovenous malformations. The surgical strategy in all groups was to thoroughly extirpate the malformation, with preservation of nerves, tendons, joints, and uninvolved muscle, and microvascular revascularization and skin replacement as required. Resections were always restricted to well-defined regions and often completed in stages. Symptomatic slow-flow malformations and types A and B fast-flow anomalies were resected without major sequelae. Type C arterial anomalies, diffuse, pulsating lesions with distal vascular steal, and involvement of all tissues, including bone, progressed clinically and resulted in amputation in 10 of 14 patients. The complication rate was 22% for slow-flow lesions and 28% for fast-flow lesions. (J Hand Surg 1999;24A:1019–1035. Copyright © 1999 by the American Society for Surgery of the Hand.)
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DOI: 10.1053/jhsu.1999.1019
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We reviewed our experience with these malformations of the upper limb in 270 patients seen over a 28-year period. These anomalies were slightly more common in females than males (ratio, 1.5:1.0). The malformations were categorized as either slow flow (venous, n = 125; lymphatic, n = 47; capillary, n = 32; combined, n = 33) or fast flow (arterial, n = 33). Three categories of fast-flow malformations were identified and designated as types A, B, and C. Over 90% of these lesions could be properly diagnosed by their appearance and growth pattern within the first 2 years of life. Additional radiographic studies were used to confirm this diagnosis and to define specific characteristics. Magnetic resonance imaging with and without contrast best demonstrated site, size, flow characteristics, and involvement of contiguous structures for all types of malformations. Algorithms for treatment of both slow-flow and fast-flow anomalies are presented. Two hundred sixty surgical resections were performed in 141 patients, including 24 of 33 fast-flow anomalies. Preoperative angiographic assessment, with magnified views, was an important preoperative adjunct before any well-planned resection of fast-flow arteriovenous malformations. The surgical strategy in all groups was to thoroughly extirpate the malformation, with preservation of nerves, tendons, joints, and uninvolved muscle, and microvascular revascularization and skin replacement as required. Resections were always restricted to well-defined regions and often completed in stages. Symptomatic slow-flow malformations and types A and B fast-flow anomalies were resected without major sequelae. Type C arterial anomalies, diffuse, pulsating lesions with distal vascular steal, and involvement of all tissues, including bone, progressed clinically and resulted in amputation in 10 of 14 patients. The complication rate was 22% for slow-flow lesions and 28% for fast-flow lesions. (J Hand Surg 1999;24A:1019–1035. Copyright © 1999 by the American Society for Surgery of the Hand.)</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Massachusetts</li></region></list><tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Upton, Joseph" sort="Upton, Joseph" uniqKey="Upton J" first="Joseph" last="Upton">Joseph Upton</name></region><name sortKey="Burrows, Patricia E" sort="Burrows, Patricia E" uniqKey="Burrows P" first="Patricia E." last="Burrows">Patricia E. Burrows</name><name sortKey="Coombs, Christopher J" sort="Coombs, Christopher J" uniqKey="Coombs C" first="Christopher J." last="Coombs">Christopher J. Coombs</name><name sortKey="Mulliken, John B" sort="Mulliken, John B" uniqKey="Mulliken J" first="John B." last="Mulliken">John B. Mulliken</name><name sortKey="Pap, Stephen" sort="Pap, Stephen" uniqKey="Pap S" first="Stephen" last="Pap">Stephen Pap</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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