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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.