Vascular malformation’s complexity lies not in its name but more so in its actual condition. Let us try to understand this condition. This condition is named so (vascular malformation) because it causes swelling of the affected area. This swelling is made up of abnormally developed (malformed) blood vessels (vascular). These abnormally developed blood vessels are present since birth, but in most of the patients, it is not evident at birth. The swelling becomes apparent only after few years and usually, it progresses gradually but sometimes it expands at a rapid rate depending upon the type of malformation. Broadly, these vascular malformations are classified as low flow and high flow malformation.

Here we are presenting a case of low flow malformation of the left hand in a 12-year-old boy. The parents of the child noticed this swelling when he was 3 years old. Initially, they observed a small swelling over his left wrist which disappeared upon lifting the arm. Gradually the swelling started increasing in size, without disappearing even after lifting the arm and the skin overlying it changed to dark bluish in color. Ideally, surgical removal of that swelling should have been done when it increased in size. Somehow, the surgery was delayed and when the parents of the child approached us, the swelling (vascular malformation) was extensive in size and involved many important tendons, muscles, and nerves of the left forearm (an area between the wrist and the elbow), wrist and extending to the palm. We carried out the necessary investigations and the surgical removal of the malformation was performed under anesthesia. This challenging task of completely removing the swelling without damaging vital structures was accomplished with the help of tourniquet (a cuff tied over the arm and inflated more than the blood pressure level so as to arrest the bleeding for a limited time) and loupes (magnifying glasses). The surgery required extreme patience and finesse from our side.

Ultimately, the child was permanently cured of his low flow vascular malformation without any functional problems, albeit with a scar which was inevitable.