Evaluation and Treatment of Musculoskeletal Vascular Anomalies in Children: An Update and Summary for Orthopaedic Surgeons

The majority of vascular anomalies can be categorized as either hemangiomas or vascular malformations. Hemangiomas are the most common benign soft tissue tumors of childhood, occurring in 4%–10% of children [16]. Vascular malformations represent a separate group of congenital vascular anomalies. Both hemangiomas and vascular malformations are often located deep to the deep fascia in the trunk and extremities of children and can present with signs and symptoms similar to that of malignant soft tissue tumors such as rabdomyosarcomas. Given the high prevalence of vascular anomalies in the pediatric population, and the need to distinguish them quickly and accurately from other soft tissue tumors, any orthopaedic surgeon treating children must have a solid understanding of the presentation, diagnosis, and prognosis of hemangiomas and vascular malformations. Confusion still exists in the literature and among clinicians about classification and treatment of these vascular anomalies. The biological classification system proposed by Mulliken and Glowacki [17] offers a simple and effective means of evaluating and diagnosing children with vascular anomalies and aids in the formulation of appropriate treatment plans.