The rare complication of vascular malformations of the limb after sclerotherapy: a report of 3 cases and brief literature review.

BACKGROUND: Vascular malformations are common but complicated types of disease in infants, with unclear causes and lack of effective prevention. The symptoms usually do not disappear and tend to progress without medical intervention. It is extremely necessary to choose correct treatment options for different types of vascular malformations. A large number of studies have confirmed that sclerotherapy has a tendency to become the first-line treatment in near future, but it is also associated with mild or severe complications. Furthermore, to our knowledge, the serious adverse event of progressive limb necrosis has not been systematically analyzed and reported in the literature. CASE PRESENTATION: Three cases (two females and one male) were presented who were all diagnosed as vascular malformations and were treated by several sessions of interventional sclerotherapy. Their previous medical records showed the use of several sclerosants in different sessions including Polidocanol and Bleomycin. The sign of limb necrosis did not occur during the first sclerotherapy, but after the second and third sessions. Furthermore, the short-term symptomatic treatment could improve the necrosis syndrome, but could not change the outcome of amputation. CONCLUSION: Sclerotherapy undoubtedly tends to be the first-line treatment in near future, but the adverse reactions still remain major challenges. Awareness of progressive limb necrosis after sclerotherapy and timely management by experts in centers of experience of this complication can avoid amputation.

Outcomes of free anterolateral thigh perforator flaps versus free modified latissimus dorsi myocutaneous flaps for Gustilo type IIIB open tibial fractures with necrosis and infection.

BACKGROUND: Infection and non-union of fractures are potential complications of Gustilo type IIIB open tibial fractures. It is important to choose the most effective type of flap to reduce the incidence of infection and non-union. METHOD: This study reviewed outcomes of 44 patients (aged 16-65 years) who underwent reconstruction of Gustilo type IIIB tibial fractures from January 2004 to January 2017. Patients received a free anterolateral thigh perforator flap (ALTP; n = 23) or modified latissimus dorsi myocutaneous flap (MLD; n = 21). Demographic data, intraoperative data, postoperative complications, and long-term outcomes were compared between groups. RESULTS: Flap complications occurred in 8 patients (18.2%) after flap reconstruction: 6 in the ALTP group and 2 in the MLD group (P < 0.05). No patient developed total flap necrosis. Rates of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) normalization were higher in the MLD group than in the ALTP group at 2 and 4 weeks after flap transfer (P < 0.05). By 6 months, fracture union occurred in 52.4% of patients in the MLD group and 30.4% of those in ALTP group (P < 0.05). By 9 months, union occurred in 85.7% of MLD group patients and 52.2% of MLD group patients (P < 0.05). CONCLUSION: MLD was associated with fewer flap complications, shorter time to ESR and CRP normalization, and higher union rates by 6 and 9 months, compared with ALTP. These results suggest that MLD may provide a better environment for reducing susceptibility to infection and promoting fracture healing in Gustilo type IIIB tibial fractures with necrosis and infection.