Contemporary management of vascular malformations.

PURPOSE: To review the literature on vascular malformations and to clarify their diagnosis, clinical presentation, and treatment options. MATERIAL AND METHODS: The authors reviewed the current literature on vascular malformations looking for more innovative and credited diagnostic criteria and treatment protocols. RESULTS: The review is divided in 4 sections (capillary, venous, arteriovenous, and lymphatic malformations). In each section, the clinical presentation, radiologic features, and treatment options for each kind of vascular malformation are described. The experience and results of the authors also are presented. CONCLUSIONS: Vascular malformations are a heterogeneous group of diseases. Each type of malformation has unique features that make it largely different from the others. Only a clear and correct diagnosis can lead to optimal results.

Haemostatic squeezing and purse-string sutures: optimising surgical techniques for early excision of critical infantile haemangiomas.

BACKGROUND/PURPOSE: Surgical excision of critical infantile haemangiomas (HMs) is usually delayed until intralesional blood flow spontaneously decreases, but fibrofatty tissue and exuberant skin invariably remain even after total involution. The aim of this study was to describe 2 surgical techniques used for early excision in 50 selected cases of HM defined critical in site or size. METHODS: Among a total of 952 patients affected by HM observed from 1999 to 2005, 50 children (5.2%) were submitted to early surgical removal of the tumour (age range, 6-24 months). In group 1, a technique of lenticular incision and linear closure was used in 34 patients using an original clamp for haemostasis during excision. In group 2, a modified round-block excision and purse-string closure technique was performed in 16 patients. RESULTS: Only 2 patients required transfusion to replace intraoperative blood losses. Infection, delayed wound healing, and cheloids occurred in 3 patients in group 2. Satisfactory cosmetic results have been observed in most cases in both groups at a follow-up ranging from 6 months to 6 years. CONCLUSIONS: The range of indications for early surgical removal of critical HM might be enlarged to achieve earlier the better cosmetic results. A few surgical tricks can minimize intraoperative bleeding and optimise the surgical scar.

Superior vena cava replacement in thymic tumours treated with radio-chemotherapy.

From 1987 to 2000 108 patients were operated on for thymic tumours. Two of these underwent replacement of the superior vena cava with polytetrafluoroethylene prostheses because the tumours invaded the superior vena cava. One of these was affected by myasthenia gravis, and was treated preoperatively with concurrent radio-chemotherapy and lymphocytopheresis. The other received preoperative chemotherapy and post-operative radio-chemotherapy because of minimal residual disease. The clinical courses of the two patients are reported here and we conclude that eradication of thymic malignancies is suitable even when superior vena cava replacement is required, and that neither antimyasthenic therapy nor adjuvant and/or neoadjuvant treatment interfere with aggressive surgical management or vice versa. Moreover, the long-term survival of one of these patients despite relapse of disease shows that extended surgery is indicated in these cases.