Resection of a venous malformation of the left thumb

Image 1 of 5

At birth, a local lesion had been noticed on the extensor side of the left thumb. At the age of 11 months this lesion had enlarged and presented with darkened skin. This picture was taken at the age of 18 months.

Explanations

Circumscribed mass

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Image 2 of 5

Same age, view from the side. In sonography, the lesion measured 10 x 12 mm, was not easily demarcated from the surrounding tissue, and showed very little blood perfusion. The lesion was expected to be a hamartoma.

Explanations

Mass

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Image 3 of 5

At the age of 20 months, open resection was performed. Intraoperatively, the lesion was intimately fused to the skin and was therefore excised together with the overlying skin.

Explanations

Mass

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Image 4 of 5

After complete resection, the extensor tendon is exposed and covered with its peritendineum. This allows for coverage with a full-thickness skin graft.
Histologically, an in toto excised venous malformation was confirmed. Small capillary vascular webs and thin-walled lacunar dilated vessels were described in the corium.

Explanations

Extensor tendon

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Image 5 of 5

Situation four weeks after surgery. The skin graft healed without any problems. The red color is typical in this short postoperative interval and will fade spontaneously over time. The thumb is freely movable.

Explanations

Skin graft

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Summary

At birth, a skin discoloration was noticed on the extensor side of the left thumb. This lesion enlarged and darkened in color at 11 months of age. Sonographically, the tumor measured 10 x 12 mm, was not well delineated, and appeared avascular. A hamartoma was suspected; relying on clinical features only, the lesion could not be classified with certainty.
The lesion was intimately fused to the skin intraoperatively and was therefore excised together with the overlaying skin. The defect was covered with a full-thickness skin graft. Histologically, an in toto excised venous malformation was described.
The risk of recurrence was significantly reduced by complete excision, which was possible only by co-resection of the skin.