Laser significantly improved a debilitating lymphaticovenous
malformation: a case report
Catherine L. Leng
Maxwell S. C. Murison
Received: 1 September 2016 /Accepted: 17 October 2016 /Published online: 17 November 2016
Springer-Verlag Berlin Heidelberg 2016
Abstract Lymphaticovenous malformations are rare congenital
anomalies leading to oozing, ulceration and recurrent infections.
They are managed by a specialist multi-disciplinary team with
compression garments, symptomatic treatments and options such
as percutaneous sclerotherapy and debulking procedures.
Limited literature exists on the use of laser to seal the lymphatic
vesicles. We present a 14 years old with a debilitating
lymphaticovenous malformation of the hand for whom the risk
of amputation was reduced by the use of carbon dioxide laser.
Level of evidence: Level V, therapeutic study.
Keywords Lymphaticovenous malformation
Lymphaticovenous malformations (LVMs) are rare, slow flow,
congenital vascular anomalies. They are difficult to manage, with
oozing from lymphatic vesicles, regular infections, ulceration,
bleeding, pain, limb overgrowth in some cases (e.g. Klippel-
Trenaunay syndrome) and the associated cosmetic deformity.
The use of carbon dioxide laser has been reported for sealing
the lymphatic vesicles associated with all lymphatic
malformations . A 14-year-old girl with a complicated LVM
of her hand was treated by the senior author. She had hypertrophy
of her ulnar two digits, recurrent severe infections associated with
sepsis, severe ulceration, and multiple lymphatic vesicles. The
possibility of amputation had been broached due to the severity
of the condition. An attempt to seal the vesicles and promote
healing of the ulcers with a carbon dioxide laser by the senior
author was very successful, and meant that amputation was not
required to control the condition in the short-term.
A 14-year-old girl had a congenital abnormality of her right hand.
At birth, she had marked swelling of the ulnar side of the hand
affecting the little and ring fingers and the dorsum. It was soft,
lipomatous, non-compressible, and there was no extra length of
the involved digits. She had no significant family history. The
initial working diagnosis was congenital lymphoedema. At
4 months, the hand was growing in proportion with her, and
further assessment was planned for when she reached 18 months.
By this time, there had been no redness, infection or oozing
and no evidence of associated pain. A plain X-ray showed no
bony abnormalities and debulking surgery was planned. Before
this surgery, at 20 months, the hand became infected and was
resistant to intravenous combination antibiotic therapy (Fig. 1).
She became systemically unwell and emergency surgical decom-
pression was performed of the dorsum of the hand and the in-
fected macrodactyly (Fig. 2). After 2 days, the clinical picture
had improved dramatically, and the wounds were closed. Two
months later, a second infection was managed with intravenous
antibiotics. At 23 months, debulking of the macrodactyly and the
dorsum of the hand was performed. Once healed, the area was
managed with compression garments and two further episodes of
swelling were managed conservatively before 6 years. At
11 years, she had successful surgery for extension contractures
of her ring and little fingers, (resection of the scars, extensor
tenolysis, metacarpophalangeal joint (MCPJ) capsulotomy and
multiple z-plasties) (Fig. 3). Until 12, she had been managed
conservatively for regular swelling, colour change and infections
and the fingers had remained consistently warm and perfused.
* Charlotte Defty
Welsh Centre for Burns and Plastic Surgery, Morriston Hospital,
Swansea SA6 6NL, UK
Whiston Hospital, Warrington Road, Prescot,
Liverpool L355DR, UK
Eur J Plast Surg (2017) 40:157–160