Management of Lymphatic Malformations

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Management of Lymphatic Malformations Arin K. Greene, MD, MMSc, Chad A. Perlyn, MD, PhD, Ahmad I. Alomari, MD, MSc Clinics in Plastic Surgery Volume 38, Issue 1, Pages 75-82 (January 2011) DOI: 10.1016/j.cps.2010.08.006 Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 1 Management of macrocystic LM. (A) A 3-year-old girl with a LM of the left orbit causing exotropia and ptosis. (B) Axial T2 MR shows a large hyperintense lesion with multiple, thin internal septations in the superolateral compartment of the orbit. (C) Postcontrast T1 MR depicts septal enhancement. There are 2 different signal intensities owing to fluid-fluid levels from intralesional bleeding. (D) Fluoroscopic image after needle aspiration and the injection of opacified doxycycline. (E) Posttreatment MR demonstrates almost complete resolution of the LM. (F) The patient is asymptomatic 4 months after sclerotherapy. Clinics in Plastic Surgery 2011 38, 75-82DOI: (10.1016/j.cps.2010.08.006) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 2 Management of localized LM. (A) A 12-year-old boy with a painful, bleeding, microcystic LM of the foot. (B) A 10-year-old girl with a well-localized, combined macro/microcystic LM of her knee causing pain and bleeding. There was no recurrence 1 year after resection. Clinics in Plastic Surgery 2011 38, 75-82DOI: (10.1016/j.cps.2010.08.006) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 3 Management of microcystic LM. (A) An 18-month-old boy with a LM of the left lower extremity interfering with ambulation and clothing. (B) T2 axial MR shows primarily microscystic LM not amenable to sclerotherapy. (C) There was no recurrence 18 months after resection. Clinics in Plastic Surgery 2011 38, 75-82DOI: (10.1016/j.cps.2010.08.006) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 4 Operative management of extensive LM. (A) An 11-year-old boy presents with chronic bleeding, pain, and discharge. He had previous subtotal resections in infancy complicating local flap closure. (B) After resection of involved skin and subcutaneous tissue the wound is allowed to heal secondarily. (C) Twelve months postoperatively the area of LM is decreased and replaced by scar. Bleeding, pain and discharge are significantly improved. (D) Second-stage excision and healing by secondary intention. (E) Two months postoperatively the wound continues to contract and the patient is asymptomatic. Clinics in Plastic Surgery 2011 38, 75-82DOI: (10.1016/j.cps.2010.08.006) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 5 Management of cutaneous microcystic LM with carbon dioxide laser. (A) An 8-year-old girl with a diffuse, superficial LM causing bleeding, pain, and discharge. (B) Carbon dioxide laser ablation of lymphatic vesicles. (C) Nine months after treatment the patient is asymptomatic. Clinics in Plastic Surgery 2011 38, 75-82DOI: (10.1016/j.cps.2010.08.006) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 6 Surgical management of microcystic LM of the tongue causing macroglossia. (A) Intraoperative view showing the “W” resection pattern. (B) Excised specimen. Clinics in Plastic Surgery 2011 38, 75-82DOI: (10.1016/j.cps.2010.08.006) Copyright © 2011 Elsevier Inc. Terms and Conditions