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Intramuscular venous malformations (IMVM) of the lower limb are rare and can be highly symptomatic. There are few reports of IMVM focused on muscles in the posterior compartment of the leg. Indications of surgery, for symptomatic patients, were discussed on account of risk of functional sequels. We retrospectively reviewed 57 patients with IMVM located in the calf, treated by surgery between 2010-2015 in a single institution. The common complaints were pain (96%), muscle contracture with toe walk (10%) and pulmonary embolism like initial symptom (7%). Muscles involved were soleus muscle (58%), gastrocnemius muscle (35%) and deep muscles (7%). Details of surgical excisions are as followed: complete excision of IMVM (91%), partial excision (9%). Associated procedures were tendinous transposition (5%), excision of tibial artery and vein (5% for ectasic tibial veins), muscle lengthening (5% for equinus deformity). At the last follow-up, 88% had no residual pain, 92% had normal occupational activities with no functional sequels. Medical management, sclerotherapy and surgery are treatments for IMVM. Surgery seems more effective than sclerotherapy to improve pain and muscle dysfunction. [ABSTRACT FROM AUTHOR]

Abstract: Treatment of venous malformations (VM) is difficult as these lesions are ill defined and can infiltrate tissues. Moreover, no specific treatment related to their etiopathogenesis exists. Currently, VM can be treated conservatively or medically and, more aggressively with either sclerotherapy, or surgical resection. A multidisciplinary approach is needed to obtain the best result with minimal complications. Surgical resection, complete or partial, plays an important role in the treatment of symptomatic VM. In case of extensive VM, all techniques of plastic surgery are indicated. [Copyright &y& Elsevier]

Vascular medicine plays a determining role in the management of vascular malformation, especially venous malformations. Ideally, therapeutic decision should be made in a multidisciplinary staff meeting. Vascular medicine plays the leading role for diagnosis and duplex-Doppler evaluation of coagulation disorders, potentially associated with an assessment of treatment feasibility using chemical or thermic endovascular techniques. Potential adherence of compression therapy must also be evaluated. Decision trees often mention sclerotherapy for the management of venous malformations. Echo-guided foam sclerotherapy is preferred. The superiority of foam sclerotherapy over liquid sclerotherapy has been demonstrated. Indications and limitations of this specific treatment remain to be definitively determined, especially for treatments with radiological control. Side effects are now well described for the use of foam sclerotherapy for venous malformations. They remain limited. Future developments should help optimize the sclerosing effect of currently used foams or other products to be developed. For the vascular medicine specialist, the main contribution is to define the appropriate use of echo-guided sclerotherapy., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Management of vascular malformations and vascular tumors has recently been maximized by the establishment of an accurate clinical and histological classification and by the development of multidisciplinary expert consultations. Head and neck localizations of venous malformations are common, thus maxillo-facial surgeons should be aware of the characteristics of this pathology and the principles of its management. Diagnosis is mainly clinical and must be certified by Doppler-ultrasonography and contrast enhanced magnetic resonance imaging with T2 fat-saturation sequence. Therapeutic decision depends on the volume of the lesion, and on functional, cosmetic and psychological complaints. Sclerotherapy is now the preferred treatment of head and neck venous malformations. It is performed in specialized interventional radiology units by intralesional injections of sclerosing solution under fluoroscopic guidance. Surgery is useful in some cases, either on its own or following sclerotherapy. In case of bulky lesion, it is necessary to search for and prevent a severe coagulopathy before planning any intervention., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)