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Volume 05
Neonatal and Pediatric Medicine
ISSN: 2572-4983
World Pediatrics 2019
December 04-05, 2019
December 04-05, 2019 | Barcelona, Spain
32
nd
World Pediatrics Conference
Limb salvage in an extensive and complicated vascular lesion in an infant
Sujata Sai
Manipal Hospital, India
Background
: Extensive vascular lesions can endanger the life of a child by their virtue of consumptive coagulopathy or
cardiac failure. A conservative surgical approach is difficult and can be life-threatening due to uncontrolled bleeding. We
report successful limb salvage in an infant despite am extensive and infected arterio-venous malformation of upper limb,
complicated by severe consumptive coagulopathy
Case
: A termmale, 3.2kgs, presented with a swelling over left armdetected antenatally. Antenatal scan- soft tissue swelling
10.8 x 6.8 x 5.4cm from left shoulder to elbow with heterogeneous cystic spaces and minimal vascularity. O/E- non
compressible, no bruit heard.
Investigations
: Doppler – hypoechoic lesion+ heterogeneous echotexture, numerous cystic spaces, weak color Doppler
signal- S/O- Hemangioma MRI- lobulated soft tissue mass 17 x 16 x 9.5cm with an intensive enhancement, necrotic and
hemorrhagic areas, involving flexor and extensormuscles of the arm. Supplied by branches of axillary and brachial arteries.
Diagnosed as- Hemangioma, hence was started on propranolol 0.5 mg/kg/day. Presented at 2 months of age with severe
anemia and consumptive coagulopathy refractory to medical therapy. At 4 months of age surgery became an imperative
lifesaving mode of treatment.
Operative procedure
: Planned for amputation/disarticulation, Axillary vessels identified and controlled, Tumor excised
in toto, Flexor and extensor muscles preserved as much as possible, Radial nerve through the tumor was divided and re-
anastomosed, Disarticulation was hence avoided, HPE suggestive of AVM, Arm and handmovements preserved at 10mth
follow-up.
Discussion
: Vascular malformations are usually present at birth; they expand secondary to trauma, sepsis or hormonal
modulation. They are less likely to cause consumptive coagulopathy but can destroy, distort or cause hypertrophy of the
adjacent bone. They may shunt the blood leading to cardiac failure. Most of the vascular tumors and a few of vascular
malformations can be managed conservatively. The indication for surgery is functional or aesthetic. When medical
management fails, surgery is unavoidable.
Conclusion
: A conservative limb salvage surgery is possible even in case of an extensive vascular anomaly. A good vascular
control is a must to prevent life threatening hemorrhage in a conservative surgery.
Neonat Pediatr Med 2019, Volume: 05