Children Treated for Slow-flow Vascular Malformations: Overall Description and Focus on Complications Such as Cellulitis
DOI:
https://doi.org/10.2340/actadv.v105.43494Keywords:
cellulitis, children, infection risk, risk factors, vascular malformationAbstract
Some patients with slow-flow vascular malformations (SFVMs) develop recurring cellulitis. The main objective of this study was to describe SFVMs in children. Other objectives were to determine the frequency of cellulitis episodes, and the factors associated with the occurrence of cellulitis. This retrospective, longitudinal, single-centre study included all children with SFVMs being managed at Lille University Hospital between 1994 and 2020. Data were collected using a standardized questionnaire. After a descriptive analysis, the variables associated with the onset of cellulitis were analysed; 133 patients (median age at diagnosis: 72 months; 53% girls) were included. SFVMs were: venous (81%), lymphatic-venous (10%), capillary-venous (5%), and lymphatic (4%). Nine children had presented at least 1 episode of cellulitis (7%, 95% CI: 4–12) and 29 episodes were reported (median: 3, interquartile range: 2–4; median age at the first episode: 3.5 years). Cellulitis occurred more frequently in young children, with lymphatic and syndromic forms of SFVM, large SFVMs, affecting skin folds, and without long-term SFVM treatment. In conclusion, the occurrence of cellulitis in patients with a SFVM is
rare. However, after the first episode, it frequently becomes recurrent, particularly in some patients with identified risk factors, who may require antibiotic prophylaxis.
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References
Yilmaz L, Kacenelenbogen N. Cutaneous vascular anomalies in children. Rev Med Brux 2015; 36: 34857.
Dasgupta R, Fishman SJ. ISSVA classification. Semin Pediatr Surg 2014; 23: 15861. DOI: https://doi.org/10.1053/j.sempedsurg.2014.06.016
Garzon MC, Huang JT, Enjolras O, Frieden IJ. Vascular malformations: Part I. J Am Acad Dermatol 2007; 56: 35370; quiz 371–374. DOI: https://doi.org/10.1016/j.jaad.2006.05.066
Cahill AM, Nijs ELF. Pediatric vascular malformations: pathophysiology, diagnosis, and the role of interventional radiology. Cardiovasc Intervent Radiol 2011; 34: 691704. DOI: https://doi.org/10.1007/s00270-011-0123-0
Luks VL, Kamitaki N, Vivero MP, Uller W, Rab R, Bovée JVMG, et al. Lymphatic and other vascular malformative/overgrowth disorders are caused by somatic mutations in PIK3CA. J Pediatr 2015; 166: 1048–1054.e1–5. DOI: https://doi.org/10.1016/j.jpeds.2014.12.069
Soblet J, Limaye N, Uebelhoer M, Boon LM, Vikkula M. Variable somatic TIE2 mutations in half of sporadic venous malformations. Mol Syndromol 2013; 4: 17983. DOI: https://doi.org/10.1159/000348327
Puig S, Casati B, Staudenherz A, Paya K. Vascular low-flow malformations in children: current concepts for classification, diagnosis and therapy. Eur J Radiol 2005; 53: 3545. DOI: https://doi.org/10.1016/j.ejrad.2004.07.023
Burrows PE. Endovascular treatment of slow-flow vascular malformations. Tech Vasc Interv Radiol 2013; 16: 1221. DOI: https://doi.org/10.1053/j.tvir.2013.01.003
Salazard B, Londner J, Casanova D, Bardot J, Magalon G. The lymphatic malformations: clinical aspects and evolution. Ann Chir Plast Esthet 2006; 51: 41222. DOI: https://doi.org/10.1016/j.anplas.2006.07.010
Russell S, Watts RG, Royal SA, Barnhart DC. Group A streptococcal infection of an intramuscular venous malformation: a case report and review of the literature. Pediatr Emerg Care 2008; 24: 83941. DOI: https://doi.org/10.1097/PEC.0b013e31819080cd
Dompmartin A, Acher A, Thibon P, Tourbach S, Hermans C, Deneys V, et al. Association of localized intravascular coagulopathy with venous malformations. Arch Dermatol 2008; 144: 8737. DOI: https://doi.org/10.1001/archderm.144.7.873
Dompmartin A, Ballieux F, Thibon P, Lequerrec A, Hermans C, Clapuyt P, et al. Elevated D-dimer level in the differential diagnosis of venous malformations. Arch Dermatol 2009; 145: 123944. DOI: https://doi.org/10.1001/archdermatol.2009.296
Hung JWS, Leung MWY, Liu CSW, Fung DHS, Poon WL, Yam FSD, et al. Venous malformation and localized intravascular coagulopathy in children. Eur J Pediatr Surg 2017; 27: 1814. DOI: https://doi.org/10.1055/s-0036-1582241
Boon LM, Mulliken JB, Enjolras O, Vikkula M. Glomuvenous malformation (glomangioma) and venous malformation: distinct clinicopathologic and genetic entities. Arch Dermatol 2004; 140: 9716. DOI: https://doi.org/10.1001/archderm.140.8.971
Brouillard P, Vikkula M. Vascular malformations: localized defects in vascular morphogenesis. Clin Genet 2003; 63: 34051. DOI: https://doi.org/10.1034/j.1399-0004.2003.00092.x
Mohan AT, Adams S, Adams K, Hudson DA. Intralesional bleomycin injection in management of low flow vascular malformations in children. J Plast Surg Hand Surg 2015; 49: 11620. DOI: https://doi.org/10.3109/2000656X.2014.951051
Markovic JN, Nag U, Shortell CK. Safety and efficacy of foam sclerotherapy for treatment of low-flow vascular malformations in children. J Vasc Surg Venous Lymphat Disord 2020; 8: 107482. DOI: https://doi.org/10.1016/j.jvsv.2019.11.023
Rivas S, López-Gutiérrez JC, Díaz M, Andrés AM, Ros Z. Venous malformations: diagnosis and treatment during the childhood. Cir Pediatr 2006; 19: 7780.
Langbroek GB, Horbach SE, van der Vleuten CJ, Ubbink DT, van der Horst CM. Compression therapy for congenital low-flow vascular malformations of the extremities: a systematic review. Phlebology 2018; 33: 5–13. DOI: https://doi.org/10.1177/0268355516684694
Prise en charge des infections cutanées bactériennes courantes. Recommandations de bonnes pratiques HAS, 2019. Available from: https://www.has-sante.fr/upload/docs/application/pdf/2019-04/prise_en_charge_des_infections_cutanees_bacteriennes_courantes_recommandations.pdf
Galli L, Venturini E, Bassi A, Gattinara GC, Chiappini E, Defilippi C, et al. Common community-acquired bacterial skin and soft-tissue infections in children: an intersociety consensus on impetigo, abscess, and cellulitis treatment. Clin Ther 2019; 41: 532–551.e17. DOI: https://doi.org/10.1016/j.clinthera.2019.01.010
Haute Autorité de Santé et le Centre national de référence des maladies vasculaires rares. Protocole National de Diagnostic et de Soins (PNDS). Lymphoedème primaire. Feb 2019. [last access: July 11th, 2025] Available at: www.has-sante.fr/upload/docs/application/pdf/2019-02/pnds_lymphoedeme_primaire_final_has.pdf
Wagner KM, Lokmic Z, Penington AJ. Prolonged antibiotic treatment for infected low flow vascular malformations. J Pediatr Surg 2018; 53: 798801. DOI: https://doi.org/10.1016/j.jpedsurg.2017.05.022
Raff AB, Kroshinsky D. Cellulitis: A Review. JAMA 2016; 316: 32537. DOI: https://doi.org/10.1001/jama.2016.8825
Torres J, Avalos N, Echols L, Mongelluzzo J, Rodriguez RM. Low yield of blood and wound cultures in patients with skin and soft-tissue infections. Am J Emerg Med 2017; 35: 115961. DOI: https://doi.org/10.1016/j.ajem.2017.05.039
Trenchs V, Hernandez-Bou S, Bianchi C, Arnan M, Gene A, Luaces C. Blood cultures are not useful in the evaluation of children with uncomplicated superficial skin and soft tissue infections. Pediatr Infect Dis J 2015; 34: 9247. DOI: https://doi.org/10.1097/INF.0000000000000768
Miller LG, Daum RS, Creech CB, Young D, Downing MD, Eells SJ, et al. Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections. N Engl J Med 2015; 372: 1093103. DOI: https://doi.org/10.1056/NEJMoa1403789
Williams DJ, Cooper WO, Kaltenbach LA, Dudley JA, Kirschke DL, Jones TF, et al. Comparative effectiveness of antibiotic treatment strategies for pediatric skin and soft-tissue infections. Pediatrics 2011; 128: e479–487. DOI: https://doi.org/10.1542/peds.2010-3681
Moran GJ, Krishnadasan A, Mower WR, Abrahamian FM, LoVecchio F, Steele MT, et al. Effect of cephalexin plus trimethoprim-sulfamethoxazole vs cephalexin alone on clinical cure of uncomplicated cellulitis: a randomized clinical trial. JAMA 2017; 317: 208896. DOI: https://doi.org/10.1001/jama.2017.5653
Kam AJ, Leal J, Freedman SB. Pediatric cellulitis: success of emergency department short-course intravenous antibiotics. Pediatr Emerg Care 2010; 26: 1716. DOI: https://doi.org/10.1097/PEC.0b013e3181d1de08
Ibrahim LF, Hopper SM, Connell TG, Daley AJ, Bryant PA, Babl FE. Evaluating an admission avoidance pathway for children in the emergency department: outpatient intravenous antibiotics for moderate/severe cellulitis. Emerg Med J 2017; 34: 7805. DOI: https://doi.org/10.1136/emermed-2017-206829
Zürcher S, Trellu LT. [Erysipèle et dermohypodermite récidivants: prise en charge]. Rev Med Suisse 2015; 11: 75962. Available from: www.revmed.ch/RMS/2015/RMS-N-468/Erysipele-et-dermohypodermite-recidivants-prise-en-charge [last access: July 11th, 2025] https://doi.org/10.53738/REVMED.2015.11.468.0759 DOI: https://doi.org/10.53738/REVMED.2015.11.468.0759
Dalal A, Eskin-Schwartz M, Mimouni D, Ray S, Days W, Hodak E, et al. Interventions for the prevention of recurrent erysipelas and cellulitis. Cochrane Database Syst Rev 2017; 6: CD009758. DOI: https://doi.org/10.1002/14651858.CD009758.pub2
Oh CC, Ko HCH, Lee HY, Safdar N, Maki DG, Chlebicki MP. Antibiotic prophylaxis for preventing recurrent cellulitis: a systematic review and meta-analysis. J Infect 2014; 69: 2634. DOI: https://doi.org/10.1016/j.jinf.2014.02.011
Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59: e10–52. DOI: https://doi.org/10.1093/cid/ciu296
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