Current management of hemangiomas and vascular malformations

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Pathogenesis

Hemangiomas are endothelial tumors with a unique biologic behavior—they grow rapidly, regress slowly, and never recur. The three stages in the life cycle of a hemangioma, each characterized by a unique assemblage of biologic markers and processes, are (1) the proliferating phase (0–1 year of age), (2) the involuting phase (1–5 years of age), and (3) the involuted phase (>5 years of age). These stages are typically clinically apparent and can be distinguished microscopically and

Classification

Vascular malformations result from errors of embryonic and fetal development. The classification of these anomalies is based on the clinical, radiologic, and histologic appearance of the abnormal channels, which may be either hematic or lymphatic in nature. A vascular malformation can be slow-flow (ie, capillary, lymphatic, or venous) or fast-flow (ie, arterial). If there are combinations of these elements, the malformation is called an arteriovenous malformation (AVM), lymphatico-venous

Summary

Patients with vascular anomalies were previously outcasts in the medical system. The internet has facilitated patient family communication and the advent of far-reaching support groups. With the advent of multidisciplinary clinics, physicians have found new ways to combine therapies for these complex patients. The plastic surgeon plays an essential role in defining this care.

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