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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE
A Journal on Physiopathology and Surgery of the Foot
Indexed/Abstracted in: EMBASE, Scopus
Chirurgia Del Piede 2001 March;25(1):1-8
Modern tactics and techniques in the treatment of angiodysplasias of the foot
Loose D. A.
Clinical findings in patients demonstrating congenital vascular malformations of the foot region especially make it clear that it is mandatory to follow the Hamburg Classification (1988). So it is possible to distinguish the different predominant morphologic structures: arterial, venous, lymphatic, arteriovenous, combined. They can exist in two different pathoanatomical forms: truncular (dysembryoplasia of nondifferentiated stem vessels) and extratruncular (residual parts of the primitive capillary plexus). The step by step diagnostics contain the assessment of the clinical picture and the functional examinations. In addition there are screening tests (noninvasive) and special investigations (invasive). It is mandatory to get precise diagnostic information about the involvement of the four compartments of the foot. This is the basis for the access surgery to the different regions of the foot. There were developed eight main accesses. The treatment follows six basic principles and it must be early, causal and adapted to the individual symptoms of the pathoanatomical, functional and clinical syndrome. Furthermore there are nonsurgical and surgical techniques in the treatment, which are applied isolated or in combination with surgery. The surgical treatment follows six tactics: 1) reconstructive operations, 2) operations to reduce AV-shunts (hemodynamic non-radical operations), 3) operations to remove the vascular defect, where feasable (devascularization), 4) combined treatment, 5) unconventional surgery, 6) multidisciplinary surgery. These tactics have clear indications and different specific surgical techniques, which are demonstrated and explained. More than 950 patients with congenital vascular malformations have been treated. 20% of this number pertain to the foot region, which are 190 patients. The overall late results worked out in a multicenter study of all localizations of vascular malformations were excellent and good in 57% and showed an improvement in additional 34%.