Journal of Pediatric Care

Limb salvage in an extensive and complicated vascular lesion in an infant

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 Report: A term male, 3.2kgs, presented with a swelling over left arm detected 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 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 to; 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.

Author(s):

Sujata Sai

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