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The fate of long-standing port-wine stain and its surgical management

 Kwan Chul Tark  ;  Dae Hyun Lew  ;  Dong Won Lee 
 PLASTIC AND RECONSTRUCTIVE SURGERY, Vol.127(2) : 784-791, 2011 
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Adolescent ; Adult ; Female ; Free Tissue Flaps* ; Humans ; Laser Therapy ; Male ; Middle Aged ; Port-Wine Stain/complications ; Port-Wine Stain/pathology* ; Port-Wine Stain/surgery* ; Retrospective Studies ; Skin Transplantation ; Time Factors ; Treatment Outcome ; Young Adult
BACKGROUND: A port-wine stain begins with thin macular lesions and eventually becomes hypertrophic and forms nodules. Although laser therapy for port-wine stain is a safe treatment modality that has been well-established, the long-standing port-wine stain has a tendency to respond less well to laser treatment. The authors performed total surgical resections of long-standing port-wine stain in the facial region, and attempted to clarify the histomorphologic changes. METHODS: The records of 15 patients with long-standing port-wine stain were reviewed for nodules and associated characteristics. After removal of the vascular lesions, the affected area was reconstructed with a radial forearm free flap or a skin graft depending on cosmetic considerations. All specimens obtained from resection were stained with hematoxylin and eosin and Victoria blue for elastic fibers for histomorphologic analysis. After a mean follow-up period of 12 years, the outcomes of surgical management were assessed. RESULTS: The nodules developed in 13 patients, and the mean age for nodule onset was 30 years. Victoria blue staining of the nodular lesions showed an intermingling of thick-walled vessels with abundant elastic fibers and thin-walled vessels without elastic fibers, which are findings typical of arteriovenous malformations. After surgical management, most of the outcomes were satisfactory, without complications or recurrence at long-term follow-up. CONCLUSIONS: A long-standing nodular port-wine stain can convert to a high-flow malformation with an arterial component, and these lesions are different from early-stage port-wine stains. For the treatment of long-standing port-wine stain that is resistant to laser therapy, surgical methods will bring more satisfactory outcomes than traditional laser therapy.
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1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
Lew, Dae Hyun(유대현)
Lee, Dong Won(이동원) ORCID logo https://orcid.org/0000-0003-0046-3139
Tark, Kwan Chul(탁관철)
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