Ilizarov-assisted periosteal distraction for refractory arteriovenous malformation ulcers: first clinical report in Asia

PMCID: PMC12175424

PMID: 40533860

DOI: 10.1186/s41065-025-00479-4

Journal: Hereditas

Publication Date: 2025-6-18

Authors: Wu X, Cai R, Ye M, Yang X, Sun D, et al.

Key Points

• Ilizarov periosteal distraction provides a novel mechanotherapeutic approach for AVM-related ischemic ulcers
• 75% wound epithelialization achieved within 4 weeks of intervention
• Offers a potential alternative to amputation in refractory AVM-associated wounds

Summary

This case report addresses the challenging management of refractory ulcers in arteriovenous malformations (AVMs), focusing on a 28-year-old female with a non-healing dorsal foot ulcer resistant to multiple previous interventions. Genetic testing revealed a KRAS mutation, providing insight into the underlying pathophysiology of the AVM. The authors employed an innovative approach using Ilizarov-assisted periosteal distraction to improve local perfusion and wound healing, demonstrating a novel mechanobiological strategy for managing complex ischemic ulcers.

The intervention yielded promising results, with 75% wound epithelialization and complete infection resolution within 4 weeks postoperatively. Unlike traditional approaches such as embolization or microvascular flap reconstruction, the Ilizarov technique leverages mechanical tension to upregulate angiogenic factors, recruit mesenchymal stem cells, and enhance capillary sprouting. This approach offers a potentially less invasive alternative for patients with compromised vascular beds and persistent wound healing challenges.