Ilizarov-assisted periosteal distraction for refractory arteriovenous malformation ulcers: first clinical report in Asia
Xiangyi Wu,
Ren Cai,
Mao Ye,
Xitao Yang,
Dachuan Sun,
Yifeng Han,
Xindong Fan,
Jiaxue Zhu
Affiliations
Xiangyi Wu
Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
Ren Cai
Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
Mao Ye
Department of Orthopedics, Fengcheng Hospital Affiliated to Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University
Xitao Yang
Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
Dachuan Sun
Department of Orthopedics, Fengcheng Hospital Affiliated to Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University
Yifeng Han
Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
Xindong Fan
Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
Jiaxue Zhu
Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
Abstract Refractory ulcers caused by high-flow arteriovenous malformations (AVMs) pose significant therapeutic challenges due to persistent tissue ischemia and shear stress-induced graft failure. Traditional embolization or flap reconstruction strategies often yield suboptimal outcomes, particularly in weight-bearing regions. We present a 28-year-old female with a non-healing dorsal foot AVM ulcer despite multiple embolizations and radical toe amputations. Genetic testing revealed a KRAS mutation, confirming a somatic etiology of AVM. After a debridement and local flap repair, we employed Ilizarov-assisted periosteal distraction to improve local perfusion. 75% of the wound epithelialized and the infection resolved within 4 weeks postoperatively, with granulation tissue covering the remainder. This case highlights the mechanobiological advantages of Ilizarov-based neovascular stimulation in AVM-related ischemic ulcers.
