Chapter: Venous malformations
Article: 8 of 13
Update: Mar 25, 2021
Author(s): Barbera, Letterio Christian
Sequelae occur in the affected body part when the development of neighboring structures such as bones, joints, muscles and tendons is disturbed by the expansion of the venous malformation. It can be assumed that both displacement, disturbed microcirculation (reduced oxygenation in the case of congestion) and restricted use play a role. In addition, segmental overgrowth and undergrowth syndromes may also occur, which according to recent findings are attributable to somatic mutations. These cases are characterized by increased asymmetry of the affected body parts.
The locally occurring musculoskeletal impairment is further aggravated by the asymmetry to the contralateral side. Growth is impaired, which can lead to misalignments of the facial skull, the spinal column and the extremities. Large venous malformations in the face can interfere with food intake, hearing, speech or visual acuity, so therapy should begin early to avoid psychomotor developmental delays. Extensive venous malformations on the forearm and hand muscles are painful and impair finger mobility. An infant’s sensory perception will be disturbed. Gripping, climbing and writing will be difficult or impossible to perform, depending on the dominant hand. These functional impairments must be recognized and addressed at an early stage. Large venous malformations on the leg can hinder walking and running, which can isolate the child from schoolmates and friends.
Significant motor impairments often impair social interactions as well. The attending physician and the therapeutic team should not be influenced by the visual appearance, the imaging findings or the current complaints alone, but should always ask themselves about the resulting future functional consequences. Potential disabilities should be recognized and avoided in advance.