Surgical management of arteriovenous malformation
Surgical management of arteriovenous malformation
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DOI：
10.1016/j.bjps.2010.05.033
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发表时间：
2011-03-01
影响因子：
2.7
通讯作者：
Tan, Swee T.
中科院分区：
文献类型：
--
作者：
Visser, Anniek;FitzJohn, Trevor;Tan, Swee T.
这篇文章介绍了我们在管理一系列连续的动静脉畸形（AVM）患者的经验，这些患者被转介到我们的血管异常中心超过14年的时间。这些患者从我们1996-2010年的前瞻性血管异常数据库中筛选。对这些患者的医疗记录进行了审查，以补充所收集的数据。在1131例血管异常患者中，53例（男性22例，女性31例）被确诊为AVM。平均年龄29岁（范围3-88岁），其中iii期14例，ii期34例，i期5例，累及头颈部32例，下肢13例，上肢7例，躯干1例。8例患者（8例iii期）和14例患者（15例ii期）在术前栓塞后接受了最终手术。17例患者需要游离皮瓣（n = 8）或局部或区域皮瓣（n = 9）重建，组织扩张（n = 4），肌腱退缩（n = 1），肌腱转移（n = 1），骨整合（n = 1）和皮肤移植（n = 5）。14例患者需要综合重建技术。在平均随访54个月（范围：10-135个月）期间，2例（8.7%）病变复发，但手术后得到改善。一名危及生命的iii期AVM患者在术前栓塞后接受了“姑息性”手术，在4年的随访期间，病变得到改善并保持稳定。AVM是一个具有挑战性的临床问题，需要多学科的团队合作。完全手术切除仍然是金标准治疗，立即重建是AVM最终手术的组成部分。AVM的异质性需要针对个别患者进行治疗，复杂的切除缺陷需要各种重建技术的专业知识。我们的经验表明，在AVM的最终手术后复发率为8.7%。(C) 2010年英国整形、重建和美容外科医师协会。Elsevier Ltd.出版。版权所有。
This article presents our experience in managing a series of consecutive patients with arteriovenous malformation (AVM) referred to our Vascular Anomalies Centre over a 14-year period. These patients were culled from our prospective Vascular Anomalies Database 1996-2010. The medical records of these patients were reviewed to supplement the data collected.Out of 1131 patients with vascular anomalies, 53 patients (22 males, 31 females) with AVM were identified. Their mean age was 29 (range: 3-88) years with 14 stage-III, 34 stage-II and five stage-I AVMs, affecting the head and neck area (n = 32), lower limb (n = 13), upper limb (n = 7) and trunk (n = 1). Eight patients with eight stage-III and 14 patients with 15 stage-II AVMs underwent definitive surgery following preoperative embolisation in 10 patients. Seventeen patients required reconstruction with free flaps (n = 8) or local or regional flaps (n = 9), tissue expansion (n = 4), tendon recession (n = 1), tendon transfer (n = 1), osseo-integration (n = 1) and skin grafting (n = 5). Fourteen patients required a combination of reconstructive techniques. During an average follow-up of 54 (range: 10-135) months, two (8.7%) lesions recurred but were improved following surgery. One patient with life-threatening stage-III AVM underwent 'palliative' surgery following preoperative embolisation and the lesion had improved and remained stable during the 4-year follow-up period.AVM is a challenging clinical problem that requires a multidisciplinary team approach. Complete surgical excision remains the gold-standard treatment and immediate reconstruction is an integral part of definitive surgery for AVM. The heterogeneous nature of AVM requires treatment to be tailored for individual patients and the complex excision defects necessitate expertise in a variety of reconstructive techniques. Our experience shows a recurrence rate of 8.7% following definitive surgery for AVM. (C) 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.