Sujata Sai
Manipal Hospital, India
Title: Limb salvage in an extensive and complicated vascular lesion in an infant
Biography
Biography: Sujata Sai
Abstract
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 an extensive and infected arterio-venous malformation of upper limb, complicated by severe consumptive coagulopathy
Case: A term male, 3.2kgs, presented with a swelling over left arm detected antenatal. 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/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 17x16x9.5cm with an intensive enhancement, necrotic and hemorrhagic areas involving flexor and extensor muscles of the arm. Supplied by branches of axillary and brachial arteries. Diagnosed as-Hemangioma hence was started on propranolol 0.5 mg/kg/ day. 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.
- Arm and hand movements preserved at 10mth follow-up
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.