The Fate of Long-Standing Port-Wine Stain and Its Surgical Management

Abstract

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. 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. 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. 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.