Plastic Surgery for Capillary Malformations Workup

  • Author: Ashok Tholpady, MD, MSc; Chief Editor: Gregory Caputy, MD, PhD, FICS   more...
 
Updated: Jan 31, 2012
 

Imaging Studies

  • For concerning lesions, appropriate imaging studies include computed tomography (CT), magnetic resonance imaging (MRI), and spinal radiography.[3]
  • Magnetic resonance angiography can be used to help document the presence or absence of enlarged vessels in vascular anomalies based on the presence of gradient recall echo sequences. Confirm the diagnosis with appropriate clinical history and physical examination findings.
  • MRI findings may serve as a guide for planned surgical excision.
  • Doppler studies can be used to evaluate the flow pattern of the lesion. Arterial malformations demonstrate high flow; this is a noninvasive method of differentiating them from capillary malformations.
Next

Histologic Findings

Capillary malformations have normal ultrastructural characteristics and normal endothelial mitotic activity. Typical Weibel-Palade bodies, smooth endoplastic reticulum, and fenestrated postcapillary venules may be observed using electron microscopy. Pericytes only partially cover endothelial cells.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Ashok Tholpady, MD, MSc  Resident Physician, Department of Pathology and Laboratory Medicine, University of Texas Medical School at Houston

Ashok Tholpady, MD, MSc is a member of the following medical societies: Academy of Clinical Laboratory Physicians and Scientists, American Society for Clinical Pathology, College of American Pathologists, Harris County Medical Society, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas J Gampper, MD  Vice Chair, Department of Surgery, Director of Aesthetic and Laser Surgery, Associate Professor, Departments of Plastic Surgery and Clinical Neurosurgery, University of Virginia

Thomas J Gampper, MD is a member of the following medical societies: American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society for Laser Medicine and Surgery, American Society of Plastic Surgeons, Association of Academic Chairmen of Plastic Surgery, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Shahin Javaheri, MD  Chief, Department of Plastic Surgery, Martinez Veterans Affairs Outpatient Clinic; Consulting Staff, Advanced Aesthetic Plastic & Reconstructive Surgery

Shahin Javaheri, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Wayne Karl Stadelmann, MD  Stadelmann Plastic Surgery, PC

Wayne Karl Stadelmann, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society of Plastic Surgeons, New Hampshire Medical Society, Northeastern Society of Plastic Surgeons, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Gregory Caputy, MD, PhD, FICS  Chief Surgeon, Aesthetica Plastic and Laser Surgery Center, Inc

Gregory Caputy, MD, PhD, FICS is a member of the following medical societies: American Society for Laser Medicine and Surgery, Canadian Medical Association, International College of Surgeons, International College of Surgeons US Section, Pan-Pacific Surgical Association, and Wound Healing Society

Disclosure: Syneron Corporation Salary Speaking and teaching

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Emmanuella Joseph, MD, and William O Murtagh, MD, to the development and writing of this article.

References

  1. Geronemus RG, Ashinoff R. The medical necessity of evaluation and treatment of port-wine stains. J Dermatol Surg Oncol. Jan 1991;17(1):76-9. [Medline].

  2. Chen L, Wu J, Xu M, Chen N, Yang Y. Sturge-weber syndrome. Ann Dermatol. Nov 2011;23(4):551-3. [Medline]. [Full Text].

  3. Arneja JS, Gosain AK. Vascular malformations. Plast Reconstr Surg. Apr 2008;121(4):195e-206e. [Medline].

  4. Katugampola GA, Lanigan SW. Five years' experience of treating port wine stains with the flashlamp-pumped pulsed dye laser. Br J Dermatol. Nov 1997;137(5):750-4. [Medline].

  5. Tan OT, Sherwood K, Gilchrest BA. Treatment of children with port-wine stains using the flashlamp-pulsed tunable dye laser. N Engl J Med. Feb 16 1989;320(7):416-21. [Medline].

  6. Bjerring P, Christiansen K, Troilius A. Intense pulsed light source for the treatment of dye laser resistant port-wine stains. J Cosmet Laser Ther. Apr 2003;5(1):7-13. [Medline].

  7. Tremaine AM, Armstrong J, Huang YC, Elkeeb L, Ortiz A, Harris R, et al. Enhanced port-wine stain lightening achieved with combined treatment of selective photothermolysis and imiquimod. J Am Acad Dermatol. Jan 13 2012;[Medline].

  8. Rubin IK, Farinelli WA, Doukas A, Anderson RR. Optimal wavelengths for vein-selective photothermolysis. Lasers Surg Med. Jan 12 2012;[Medline].

  9. Kono T, Groff WF, Sakurai H. Treatment of port wine stains with the pulse dye laser. Ann Plast Surg. Apr 2006;56(4):460-3. [Medline].

  10. McGill DJ, Mackay IR. Capillary vascular malformation response to increased ambient temperature is dependent upon anatomical location. Ann Plast Surg. Feb 2007;58(2):193-9. [Medline].

  11. Raulin C, Greve B, Hammes S. Cold air in laser therapy: first experiences with a new cooling system. Lasers Surg Med. 2000;27(5):404-10. [Medline].

  12. Greve B, Hammes S, Raulin C. The effect of cold air cooling on 585 nm pulsed dye laser treatment of port-wine stains. Dermatol Surg. Jul 2001;27(7):633-6. [Medline].

  13. Nelson JS, Kimel S. Safety of cryogen spray cooling during pulsed laser treatment of selected dermatoses. Lasers Surg Med. 2000;26(1):2-3. [Medline].

  14. Chang CJ, Nelson JS. Cryogen spray cooling and higher fluence pulsed dye laser treatment improve port-wine stain clearance while minimizing epidermal damage. Dermatol Surg. Oct 1999;25(10):767-72. [Medline].

  15. Chess C. Does simultaneous contact cooling reduce intravascular temperature during laser irradiation and impinge on selective vascular destruction?. Dermatol Surg. Mar 1998;24(3):404-5. [Medline].

  16. Waldorf HA, Alster TS, McMillan K, Kauvar AN, Geronemus RG, Nelson JS. Effect of dynamic cooling on 585-nm pulsed dye laser treatment of port-wine stain birthmarks. Dermatol Surg. Aug 1997;23(8):657-62. [Medline].

  17. Breugem CC, Hennekam RC, van Gemert MJ, van der Horst CM. Are capillary malformations neurovenular or purely neural?. Plast Reconstr Surg. Feb 2005;115(2):578-87. [Medline].

  18. Astner S, Anderson RR. Treating vascular lesions. Dermatol Ther. May-Jun 2005;18(3):267-81. [Medline].

  19. Barsky SH, Rosen S, Geer DE, Noe JM. The nature and evolution of port wine stains: a computer-assisted study. J Invest Dermatol. Mar 1980;74(3):154-7. [Medline].

  20. Bauer BS, Kernahan DA, Hugo NE. Lymphangioma circumscriptum--a clinicopathological review. Ann Plast Surg. Oct 1981;7(4):318-26. [Medline].

  21. Eerola I, Boon LM, Mulliken JB, Burrows PE, Dompmartin A, Watanabe S, et al. Capillary malformation-arteriovenous malformation, a new clinical and genetic disorder caused by RASA1 mutations. Am J Hum Genet. Dec 2003;73(6):1240-9. [Medline].

  22. Enjolras O, Mulliken JB. The current management of vascular birthmarks. Pediatr Dermatol. Dec 1993;10(4):311-3. [Medline].

  23. Finn MC, Glowacki J, Mulliken JB. Congenital vascular lesions: clinical application of a new classification. J Pediatr Surg. Dec 1983;18(6):894-900. [Medline].

  24. Frech M, John J, Pizon V, Chardin P, Tavitian A, Clark R, et al. Inhibition of GTPase activating protein stimulation of Ras-p21 GTPase by the Krev-1 gene product. Science. Jul 13 1990;249(4965):169-71. [Medline].

  25. Gampper TJ, Morgan RF. Vascular anomalies: hemangiomas. Plast Reconstr Surg. Aug 2002;110(2):572-85; quiz 586; discussion 587-8. [Medline].

  26. Goldman MP, Fitzpatrick RE, Ruiz-Esparza J. Treatment of port-wine stains (capillary malformation) with the flashlamp-pumped pulsed dye laser. J Pediatr. Jan 1993;122(1):71-7. [Medline].

  27. Jacobs AH, Walton RG. The incidence of birthmarks in the neonate. Pediatrics. Aug 1976;58(2):218-22. [Medline].

  28. Katugampola GA, Lanigan SW. Five years' experience of treating port wine stains with the flashlamp-pumped pulsed dye laser. Br J Dermatol. Nov 1997;137(5):750-4. [Medline].

  29. Lanigan SW. Port-wine stains unresponsive to pulsed dye laser: explanations and solutions. Br J Dermatol. Aug 1998;139(2):173-7. [Medline].

  30. Marler JJ, Mulliken JB. Current management of hemangiomas and vascular malformations. Clin Plast Surg. Jan 2005;32(1):99-116, ix. [Medline].

  31. Mulliken JB. Cutaneous vascular anomalies. In: McCarthy JG, ed. Plastic Surgery. Philadelphia, Pa: WB Saunders; 1990:. 3191-274.

  32. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. Mar 1982;69(3):412-22. [Medline].

  33. Nelson JS, Applebaum J. Clinical management of port-wine stain in infants and young children using the flashlamp-pulsed dye laser. Clin Pediatr (Phila). Sep 1990;29(9):503-8; discussion 509. [Medline].

  34. Orten SS, Waner M, Flock S, Roberson PK, Kincannon J. Port-wine stains. An assessment of 5 years of treatment. Arch Otolaryngol Head Neck Surg. Nov 1996;122(11):1174-9. [Medline].

  35. Rak KM, Yakes WF, Ray RL, Dreisbach JN, Parker SH, Luethke JM, et al. MR imaging of symptomatic peripheral vascular malformations. AJR Am J Roentgenol. Jul 1992;159(1):107-12. [Medline].

  36. Schneider BV, Mitsuhashi Y, Schnyder UW. Ultrastructural observations in port wine stains. Arch Dermatol Res. 1988;280(6):338-45. [Medline].

  37. Smoller BR, Rosen S. Port-wine stains. A disease of altered neural modulation of blood vessels?. Arch Dermatol. Feb 1986;122(2):177-9. [Medline].

  38. Wang QK. Update on the molecular genetics of vascular anomalies. Lymphat Res Biol. 2005;3(4):226-33. [Medline].

 
Previous
Next
 
A 12-year-old boy presenting with bluish discoloration of the right thenar eminence and index finger. The lesion has been present since birth and changes in size when he raises his arms or exercises strenuously. Upon physical examination, the mass is soft and rubbery. No palpable thrill or audible bruit is present.
An image from an MRI study of the right hand of the patient in the image above, detailing the vascularity of the lesion.
Intraoperative view of the lesion in the first and second images shown above. Note the irregular mass of vessels that are adherent to the digital neurovascular bundles, tendons, and lumbrical muscle belly.
The excised specimen from the patient in the previous images.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.