Multiple treatment modalities are typically used in

Multiple treatment modalities are typically used in managing KTS, depending on the clinical presentation of each patient. Fig. 7 shows the simplified treatment protocol that we have used in managing children with lower extremity KTS. In most patients, early conservative management facilitates the control of local symptoms such as discomfort from limb swelling. Compressive therapy reduces local discomfort, limits limb swelling, and minimizes localized intravascular coagulation. We advise all of our patients to wear custom-made buy buspirone hcl garments 24 hours per day, except when taking a shower. Sclerotherapy with intravascular or intralesional sodium tetradecyl sulfate or ethanolamine oleate is useful for inducing inflammation and the subsequent obliteration of abnormal varicosities in venous malformations. Multiple sessions are necessary for different lengths of time (from months to years) to achieve disease control. Certain patients benefit from the surgical stripping off of prominent veins and varicosities in the legs and thighs. Pulsed dye laser treatment is indicated for port-wine stains, but it is only useful in superficial diseases. It may be used as an adjunct for the superficial components of deeper lesions after a successful course of sclerotherapy in capillary malformations. In patients with KTS that affects the limbs, lymphatic malformations can cause substantial limb discrepancy because of associated bone and soft tissue overgrowth. In addition, lymphatic malformations can be problematic because of recurrent infections. Furthermore, the skin can be affected and become fragile and form small vesicles that often ulcerate or bleed. Sclerotherapy has limited success because lymphatic malformations in KTS are microcystic. Performing surgery remains controversial; therefore, conservative management is widely advocated. However, debulking surgery and excision of the involved skin and soft tissue should be considered for certain patients. For postexcisional defects, skin grafts are typically sufficient for reconstruction of the lower extremities. For defects close to the joint, we recommend reconstruction with a local flap by using the expanded skin and soft tissue to preserve joint function. In 1957, Neumann first reported expansion of the skin to reconstruct a traumatic ear defect. Using a collapsed rubber balloon and an external port, the periauricular skin was serially expanded for 4 months without extrusion or infection. Expansion of the skin and soft tissue may be employed to increase the size of full-thickness skin grafts, local or regional flaps, or distant or free flaps prior to transfer. Tissue expansion has been used to reconstruct tissue in various clinical problems such as for the secondary reconstruction of burn scars, large congenital nevi, and tumor ablation. Reconstruction using the locally expanded tissue enables the resurfacing of large anatomic areas with skin of similar color, quality, and texture. The application of tissue expanders in children has been widely discussed, and numerous relevant studies have been published. We adopted a tissue expander with a low profile and an internal port system to minimize the risk of infection and exposure. The internal port should be placed away from the expander to avoid accidental puncture of the expander when accessed. The accessibility of the injection port requires careful consideration. In pediatric patients, an easy-access port site facilitates an efficient filling process and helps reduce distress in children and parents. Overinflation of tissue expanders beyond the manufacturer\'s recommended capacity seems to be the norm in clinical practice. In one clinical study, the expander was inflated to 3.5 times the manufacturer\'s stated capacity without any complications. We have routinely overinflated the tissue expander to 3–4 times the recommended capacity. At the end of the final expansion, we ensured that the expander had sufficient volume for the apical circumference of the dome of skin overlying the expander to be 2–3 times the width of the defect. Removal of the tissue expander and definitive surgery were delayed for 2–3 weeks to ensure that the expanded skin flap was pliable and viable. Previous studies have described various methods for planning tissue expansion.