YAG laser resection of complicated hemangiomas of the hand and upper extremity

Acquired Localized Subcutaneous Cavernous Vascular Malformations of the Hand

A series of 15 patients with acquired localized subcutaneous cavernous (venous) vascular malformations of the hand is reported. There were nine women and six men. The malformation was first noted at a mean age of 24 years (range, 16–40 years). Six patients had solitary lesions and nine had multiple lesions. A painful mass was the most common presenting symptom. Calcification within the malformation was noted radiologically in one-third of the patients. Patients were managed with simple excision of the symptomatic lesions with no recurrence.

Clinical and morphological characteristics of head-facial haemangiomas

Background

Haemangiomas of the head or face are a frequent vascular pathology, consisting in an embryonic dysplasia that involves the cranial-facial vascular network. Haemangiomas show clinical, morphological, developmental and structural changes during their course.

Methods

The clinical characteristics of head-facial haemagiomas were studied in 28 individuals (9 males and 19 females) admitted in our Hospital. Sixteen of these patients(n = 16) underwent surgery for the removal of the haemangiomas. All the removed tissues were transferred in experimental laboratories for the staining of microanatomical details, somatic and visceral nerve fibres, adrenergic and catecholaminergic nerve fibres. Beta-adrenergic receptors were died with a fluorescent method. All results were submitted to the quantitative analysis of images and statistical evaluation of the data.

Results

The morphological results revealed numerous micro-anatomical characteristics of the haemangiomatous vessels. The somatic and visceral nerve fibres were poor and located exclusively in the adventitial layer. There was a marked decrease of adrenergic nerve fibres in the haemangiomatous vessels. The fluorescence of catecholaminergic nerve fibres and the overall area of fluorescent structures were also decreased in haemangiomatous vessels. Beta adrenergic receptors are strongly decreased in haemangiomatous vessels. The morphometrical analysis of images and statistical evaluation of the data confirmed all our experimental results.

Conclusion

The catecholaminergic innervation of the human haemangiomatous vessels comprises nerve fibres containing the main catecholaminergic neurotransmitters that are sympathetic in nature. These neurotransmitters are closely related to beta-adrenergic receptors.

The sympathetic nervous system plays a key role in the control of the vascular bed flow and vascular motility in both normal and haemangiomatous vessels.

Microsurgical approach for a venous malformation of the thumb

We report a case of a low-flow venous malformation of the thumb treated by microsurgical excision of the mass and a free toe pulp flap. Forty-two months after surgery the patient had a good cosmetic and functional results without any recurrence of the tumour.