Lymphatic Venous Malformation
Venous and lymphaticmal formations are the abnormal bunch of vessels conducting blood/lymph.
Venous and lymphaticmal formations are the abnormal bunch of vessels conducting blood/ lymph fluid within them and forming a mass like appearance. These are called Low flow vascular malformations considering the speed of flow of fluid in them. They can be formed by venous or lymphatic or both of these vessels.
Physically they appear as very soft swellings which, on touching, feel like bag of worms, as commonly mentioned. They usually decrease in size after lying down and increase on prolonged standing. They appear bluish-pink in colour and do not cause any pain.
These can occur in any part of the body and are usually painless and the patient comes with the complaints of visible swelling which may cause complications like
- Body part disfigurement
- Recurrent ulceration or bleeding
- Oozing of fluid from the multiple vesicles present over the skin overlying the swelling (in few cases)
- Compression of underlying structures leading to related symptoms like pain, distal limb ischemia, swelling etc
- In young children, if malformation is large, it may lead to disproportionate body growth.
To avoid the above complications, early treatment as soon as diagnosis is made is recommended. In smaller children, we wait till the age of 2 years for it to regress spontaneously. If it still increases in size, treatment is done. In adults, there is no option for wait and watch. If left untreated, the swelling can become so large that to involve major blood vessels or vital organs completely. In such cases, surgery is avoided and not done because it may lead to dysfunction of the involved organ which may cause more severe complications.
Diagnosis
- Clinical examination
- Swelling with soft consistency
- Bluish color
- Increase in size in dependent position
- MRI scan is routinely done to know the anatomical extent of lesion in all the planes.
Treatment
- Medical treatment by beta blockers. It helps only in small children if the malformation is made of small capillaries
- Treatment of small, isolated lymphatic and venous malformation is ultrasound guided injection of sclerosant or bleomycin into the swelling.
- Wide local excision is the surgery of choice in lymphatic/venous malformations with preservation of surrounding vital structures.
The surgical procedure for low flow malformation can be highly challenging and technically demanding if it is big and widespead. The procedure requires a lot of preparation from both the patient and the doctor side. Feeder vessels are identified and ligated and mass is delbulked or excised.
A thorough knowledge of the vessel feeders and the anatomy, distribution of vessels and extent of the malformation should be known to the surgeon.
Possible complications, requirement of more than one stage in excision and method of coverage of created defect after the excision of malformation should be agreed upon by the patient and his or her attendants.
Sometimes in few cases, if the extent of the malformation is too extensive and deep and if the excision requires sacrifice of major vessel or nerves or endangers the survival of the part, then complete excision is not done and part of the malformation which is near to the vital structures is left behind so that the function of the part is disturbed less.
The remaining part can be excised in separate stage after few months.
May require post-surgical reconstruction with flap/skin graft cover.
- Skin grafting may be done if defect is not much deep and vitals structures are embedded deep and not exposed.
- Local Flap Reconstruction Local flap is the transfer of flap of skin from the surrounding areas to the defect site. It is done when defect is deep and surrounding area is normal and sufficient enough to cover the defect.
- Microvascular Free Flaps - which is usually done when any critical part is exposed like bones, tendons, joints and it becomes really important to preserve them for the normal functioning. A well blood supplied tissue is taken from the adjacent area or from other areas of the body to cover the part of the limb with it. The flap should be monitored frequently post-surgery. Hospital stay is increased, with respect to skin grafting or local flap procedures, but it is the best modality to cover the defects in malformation patients. Dressing is done every alternate day and patient is admitted for at least 7-8 days and discharged once the flap is settled.
Recurrence rate is high in large low flow malformations as complete excision is not possible and debulking is done to lessen the symptoms of the malformation on the body.
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Best plastic surgeon, Dr. Amit Agarwal is an American Board Certified, extensively trained, and best Plastic & Aesthetic surgeon in Lucknow. He is the Chief Plastic Surgeon heading the Department of Plastic, Microvascular, and Craniofacial surgery at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, U.P, India. He maintains a busy practice at Avadh and Nishat Hospital and his own center - Kayakriti Plastic Surgery & Dental Center. He was formerly a Consultant in the Department of Plastic Surgery and Burns at the prestigious SGPGI, Lucknow.
MS, DNB (General Surgery) MCh, DNB (Plastic Surgery),
MNAMS, FACS, FICS, FRCS (Edinburgh, UK)
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Frequently Asked Questions
If you have flat or small breast and you want to improve your breast and hip contour ratio then you are a good candidate for it. The answer will be best provided after the first consultation with Dr Amit Agarwal.
Acute pain will be there for almost a week which gradually reduces and there will be soreness and swelling which may take up to 3 weeks to subside.
You can join your work and daily routines after a week of the procedure and can start exercising after 3 weeks of it.
Yes, you have to wear it round the clock unless we suggest you to remove it.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
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D-43, Near Punjab National Bank, Rajajipuram, Lucknow, Uttar Pradesh - 226017, India
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