Paediatric Surgery (Ukraine). 2026. 2(91): 43-50. doi: 10.15574/PS.2026.2(91).4350
Zyma A. M.¹, Vyderko R. V.¹, Chernukha L. M.², Cheverda A. I.¹, Kincha-Polishchuk T. A.^1
1SI "Institute of Traumatology and Orthopedics NAMS of Ukraine", Kyiv
²SI "Shalimov’s National Science Center of Surgery and Transplantology NAMS of Ukraine", Kyiv

For citation: Zyma AM, Vyderko RV, Chernukha LM, Cheverda AI, Kincha-Polishchuk TA. (2026). Surgical treatment of musculoskeletal disorders in congenital vascular malformation of the lower extremities. Paediatric Surgery (Ukraine). 2(91): 43-50. doi: 10.15574/PS.2026.2(91).4350.
Article received: Jan 17, 2026. Accepted for publication: Jun 15, 2026.

Aim – to develop and substantiate a differentiated approach to choosing surgical treatment tactics for orthopedic manifestations of congenital vascular malformations (CVM) of the lower extremities and to evaluate the results of its application.
Materials and methods. This study is based on the analysis the results of examination and treatment of 43 patients with CVM. Surgical interventions were performed in 17 patients. Treatment outcomes were analyzed according to a developed working clinical-orthopedic classification of the functional status of the lower extremities in CVM.
Results. A differentiated approach to the surgical treatment of orthopedic manifestations in CVM was developed, with the definition of indications and contraindications for correction based on the form of CVM and the degree of hemodynamic impairment. The application of this differentiated approach to the surgical correction of leg length discrepancy (LLD), joint contractures and foot deformities gave good functional outcomes, specifically the correction of LLD, elimination of joint contractures, and correction of foot deformities. Surgical treatment led to complications in 8.6% of cases, manifested as bleeding in the early postoperative period. Long-term outcomes of surgical treatment for orthopedic manifestations indicated no progression of CVM.
Conclusions. Surgical treatment of orthopedic pathology in CVM should be well-founded, with mandatory consideration of vascular pathology. The application of a differentiated approach to the correction of orthopedic improves gait and weight-bearing function in this category of patients.
The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children's parents (or their guardians) for the research.
Authors declare that there was no conflict of interest.
Keywords: congenital vascular malformation, diagnostics, orthopedic pathology, leg length discrepancy, joint contractures, foot deformity, algorithm, surgical treatment.

REFERENCES

1. Belov S. (1993). Correction of lower limbs length discrepancy in congenital vascular-bone diseases by vascular surgery performed during childhood. Semin Vasc Surg, 6: 245-251. PMID: 8305979.

2. Benzar IM. (2017). Extracranial arteriovenous malformations in children: features of clinical course, diagnosis and treatment. Ukrainian Journal of Surgery. 35(4): 61-70. https://doi.org/10.22141/1997-2938.4.35.2017.118895

3. Benzar IM, Levytskyi AF, Diehtiarova DS, Fedoniuk LY, Stravskyy YS, Merkulova DA et al. (2020). Vascular anomalies in newborns: clinical presentation, complications, and peculiarities of therapy. Wiadomości Lekarskie. 73; 9(2): 1934-1939. https://doi.org/10.36740/WLek202009207; PMid:33148836

4. Benzar IM, Levytskyi AF, Diehtiarova DS, Godik OS, Dubrovin OH. (2022). Treatment of lymphatic malformations in children: 10 years of experience. Paediatric Surgery(Ukraine). 2 (75): 5-14. https://doi.org/10.15574/PS.2022.75.5

5. Blei F, Bittman M. (2016). Congenital vascular anomalies: current perspectives on diagnosis, classification, and management. Journal of Vascular Diagnostics and Interventions, 4: 23-37. https://doi.org/10.2147/JVD.S63244

6. Breugem CC, Maas M, Breugem SJ, Schaap GR, van der Horst CV. (2003). Vascular malformations of the lower limb with osseous involvement. J Bone Joint Surg Br. 85(3): 399-405. https://doi.org/10.1302/0301-620X.85B3.13429; PMid:12729117

7. Chernukha LM, Kashirova EV. (2015). Classification of congenital vascular malformations: a tribute to fashionable trends or an urgent necessity? View of a vascular surgeon. Pediatric surgery. 1-2(46-47): 6-17.

8. Dompmartin A, Acher A, Thibon P, Tourbach S, Hermans C, Deneys V et al. (2008). Association of localized intravascular coagulopathy with venous malformations. Arch Dermatol. 144(7): 873-877. https://doi.org/10.1001/archderm.144.7.873; PMid:18645138

9. Eklöf B, Rutherford RB, Bergan JJ et al. (2004). American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification: Revision of the CEAP classification for chronic venous disorders: consensus statement. J. Vasc. Surg. 40(6): 1251-1252.

10. Enjolras O, Chapot R, Merland J. (2004). Vascular anomalies and the growth of limbs: a review. J Pediatr Orthop B, 13: 349-357. https://doi.org/10.1097/01202412-200411000-00001; PMid:15599224

11. Kim YW, Lee SH, Kim DI, Do YS, Lee BB. (2006). Risk factors for leg length discrepancy in patients with congenital vascular malformation. J Vasc Surg. 44(3): 545-553. https://doi.org/10.1016/j.jvs.2006.05.035; PMid:16950432

12. Lee BB. (2004). Critical Issues in Management of Congenital Vascular Malformation. Annals of Vascular Surgery. 18(3): 380-392. https://doi.org/10.1007/s10016-004-0020-y; PMid:15354646

13. Lee BB. (2007). Congenital vascular malformations: general diagnostic principles. Phlebology: Venous Forum of the Royal Society of Medicine. 22(6): 253-257. https://doi.org/10.1258/026835507782655245; PMid:18274332

14. Lee BB, Laredo J, Lee TS. (2007). Terminology and classification of congenital vascular malformations. Phlebology. 22(6): 249-252. https://doi.org/10.1258/026835507782655236

15. Mattassi R, Vaghi M. (2007). Vascular bone syndrome – angioosteodystrophy: current concepts. Phlebology/Venous Forum R Soc Med. 22(6): 287-290. https://doi.org/10.1258/026835507782655263

16. Öztürk Durmaz E, Demircioğlu D, Yalınay Dikmen P, Alanay Y, Alanay A, Demirkesen C et al. (2022). A Review on Cutaneous and Musculoskeletal Manifestations of CLOVES Syndrome. Clin Cosmet Investig Dermatol. 13(15): 621-630. https://doi.org/10.2147/CCID.S351637; PMid:35444443 PMCid:PMC9013705

17. Spencer SA, Sorger J. (2014). Orthopedic issues in vascular anomalies. Semin Pediatr Surg. 23(4): 227-32. https://doi.org/10.1053/j.sempedsurg.2014.06.015; PMid:25241103

18. Tasnadi G. (1993). Epidemiology and etiology of congenital vascular malformations. Semin Vasc Surg. 6: 200-203.

19. Vyderko RV, Zyma AM, Guk YuM, Chernukha LM, Cheverda AI, Kincha-Polishchuk TA. (2022). Working orthopedic classification of the functional state of the lower extremities in congenital vascular malformations. Paediatric Surgery (Ukraine). 77 (4): 84-90. doi: 10.15574/PS.2022.77.84.