Approach Considerations

Cases should be discussed in a formal multidisciplinary meeting involving plastic surgery, pediatrics, dermatology, interventional radiology, hematology, physiotherapy, and histopathology.

Imaging Studies

Most lesions do not require investigation; for concerning lesions, however, appropriate imaging studies include ultrasonography (US), computed tomography (CT) scanning, magnetic resonance imaging (MRI), and spinal radiography.^[14]

Magnetic resonance angiography can be used to help document the presence or absence of enlarged vessels in vascular anomalies.

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

Histologic Findings

Ultrastructural characteristics and endothelial mitotic activity are normal in capillary malformations. Typical Weibel-Palade bodies, smooth endoplastic reticulum, and fenestrated postcapillary venules may be observed using electron microscopy. Capillary malformations do not stain for GLUT-1, a marker for infantile hemangiomas, so this test can be used to distinguish between the two lesions.^{[3, 4]}

Other Tests

Ophthalmologic examination should be performed if there is periocular involvement, being carried out every 6 months for the first 3 years and then annually.^[11]

Treatment & Management

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Media Gallery

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.

of 4

Author

Rohit Seth, MD, PhD, MRCS(Edin) Plastic and Aesthetic Surgeon, Private Practice, UK

Rohit Seth, MD, PhD, MRCS(Edin) is a member of the following medical societies: British Association of Plastic, Reconstructive and Aesthetic Surgeons, European Society of Aesthetic Gynecology, International Society of Aesthetic Plastic Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Alisha Patel, MBBS Senior House Officer, Department of Plastic Reconstructive Surgery and Sarcoma Surgery, The Royal Marsden Hospital, Sutton Branch, The Royal Marsden NHS Foundation Trust, UK

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Gregory Gary Caputy, MD, PhD, FICS Wound Healing Consultant, Advantage Surgical and Wound Care

Gregory Gary Caputy, MD, PhD, FICS is a member of the following medical societies: American Society for Laser Medicine and Surgery, International College of Surgeons, International College of Surgeons US Section, Wound Healing Society

Disclosure: Nothing to disclose.

Additional Contributors

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, American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Thomas J Gampper, MD, FACS Associate Professor of Plastic Surgery, Associate Clinical Professor of Neurosurgery, Director of Laser Surgery, Vice Chairman, Department of Plastic Surgery, University of Virginia School of Medicine; Director, Virginia Aesthetic Center

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

Disclosure: Nothing to disclose.

Ashok Tholpady, MD, MSc Assistant Professor, Section of Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center

Ashok Tholpady, MD, MSc is a member of the following medical societies: AABB, Association of Clinical Scientists, College of American Pathologists, Harris County Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

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.

Sections Plastic Surgery for Capillary Malformations
Overview
Workup
Treatment
Media Gallery
Tables
References

Grade 1	Sparse, pale, nonconfluent discoloration
Grade 2	Denser pink, nonconfluent discoloration
Grade 3	Red, discrete, ectatic vessels
Grade 4	Confluent patch
Grade 5	Nodular lesion

Plastic Surgery for Capillary Malformations Workup

Approach Considerations

Imaging Studies

Histologic Findings

Other Tests

References

Tables

Contributor Information and Disclosures

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