Management of pediatric intramuscular venous malformations.
BACKGROUND
Intramuscular venous malformations (VMs) are rare, but can be highly symptomatic. There are few reports on outcomes, particularly pain, functional limitations, and muscle contractures. We aimed to compare results of medical management, sclerotherapy, and surgical resection.


METHODS
We retrospectively reviewed 45 patients with an extremity or truncal intramuscular VM between June 2005 and June 2015 at a single institution. Outcomes were compared between treatment modalities with ANOVA and χ2 tests.


RESULTS
Six patients (13%) were treated with medical management, 4 (9%) with surgical resection, 23 (51%) with sclerotherapy, and 12 (27%) with both surgery and sclerotherapy. Sclerotherapy alone decreased pain in 72%. Only 20% of patients presented with muscle contracture. For these patients, 33% resolved with sclerotherapy, physical therapy, and aspirin; 22% resolved with surgery, and 45% had persistent contracture. 40% of patients treated with sclerotherapy then surgery developed new muscle contractures, compared to 4% of sclerotherapy only patients and 0% of surgery only patients (p=0.04).


CONCLUSIONS
Medical management, surgery and sclerotherapy are effective treatments for intramuscular VMs. Observation and supportive care can be a primary treatment for patients with minimal symptomatology and no functional limitations. Sclerotherapy is more effective for treating pain than contractures and when used alone, rarely causes a new muscle contracture.
Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address: meensey@gmail.com.
Minna M
MM
Wieck
Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address: nowicki@chla.usc.edu.
Donna
D
Nowicki
Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address: kschall@chla.usc.edu.
Kathy A
KA
Schall
Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address: czeinati@chla.usc.edu.
Chadi
C
Zeinati
Department of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address: lhowell@chla.usc.edu.
Lori K
LK
Howell
Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address: danselmo@chla.usc.edu.
Dean M
DM
Anselmo
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000601:surgery; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D015911:Sclerotherapy; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000628:therapy*; D014680:Veins / Q000002:abnormalities* / Q000601:surgery; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
Muscle contracture; Sclerotherapy; Vascular anomaly