A 6-year-old male presented with a 1-month history of a tumor in the hypothenar region of the right hand that became evident to his mother after suffering a fall from his own height.
This tumor has a slow and progressive growth, pulsatile, non-painful, with minimal mobility, and presents thrill to malalignment.
1.
We requested a Doppler ultrasound study that reports the existence of blood flow through the tumor ruling out its solid consistency, because we proceed to its surgical exploration.
With the patient in the operating room under the effects of balanced general anesthesia and using ischemia with a pressure of 180 mmHg in the right forearm, we performed an incision in the ulnar region identifying the proximal and distal ends of the tumor.
Complete resection of the lesion was performed, with dimensions of approximately 3 x 3 cm, leaving a gap of 5 cm between both cables.
We released forearm ischemia, which was maintained for a total time of 40 minutes.
Later we proceeded to venous graft harvesting of a superficial vein of the foot to achieve a healthy microsurgical reconstruction end-to-end of the cubital artery with 10-0 nylon using simple stitches.
We verified the adequate blood flow through anastomosis under direct vision seizures, performing permeability tests.
Finally, we confront the incision by planes and placed a splint in functional position, giving rise to surgical procedure without complications.
1.
The patient was hospitalized one day in the Service, where a dose of low molecular weight heparin (enoxaparin) calculated for his weight was applied 8 hours after the anastomosis.
The postoperative follow-up consisted of weekly revisions in the external consultation of the Service, removing the suture points 2 weeks after surgery and the splint at the third week.
We prescribe rehabilitation at home without performing active movements inside warm water, as well as with a paste and self-medication for 3 weeks, indicating the use of the hand for activities of daily living (with daily bathing, etc.).
The patient returned to his normal activities after the fourth week of surgery, without presenting any complications.
The patient was followed up for 1 year after surgery without identifying recurrence of the tumor, maintaining radial and ulnar pulses, with good capillary filling and distal temperature.
We verified in the outpatient clinic the permeability of the microvascular graft with Allen test and use of Doppler ultrasound.
