Extensive muscle necrosis and infection following treatment of a lower extremity vascular malformation with Sotradecol and absolute ethanol

Venous malformations are a subset of low-flow vascular malformations. These are usually present at birth and grow commensurate with the child. The treatment of low-flow vascular malformations has been studied extensively. Many interventions have been devised to benefit this patient population in regard to the pain, ulcerations, infections, cosmetic concerns, and overall bulk associated with these malformations. Treatment can begin with compression garments. Another treatment is sclerotherapy. This can be done as a stand-alone treatment or as an adjunct to surgical excision. Percutaneous sclerosis of venous malformations has an efficacy of between 74 and 90% in relieving symptoms. We present a case of percutaneous sclerotherapy with Sotradecol and ethanol into an extensive lower extremity venous malformation in the setting of orthopedic megaprosthesis. We feel that this led to extensive soft tissue necrosis and infection of the limb and created a precipitous situation.