Excision of a long-standing low-flow venous malformation of the fourth digit in a 30-year-old male: a case report.

Introduction and Importance: Venous malformations are benign vascular anomalies that develop from congenital defects in the venous system. Although often asymptomatic, they can progressively enlarge, potentially leading to cosmetic concerns, functional impairment, or discomfort. Case Presentation: A 30-year-old male presented with a swelling over the fourth finger of his left hand, first noticed approximately 20 years prior. The lesion had gradually increased in size to approximately 5 × 5 cm and remained asymptomatic, with no history of pain, trauma, fever, or systemic symptoms. Physical examination identified a compressible, bluish mass, indicative of vascular origin. Imaging, including ultrasound and MRI, confirmed a diagnosis of low-flow venous malformation. After comprehensive preoperative evaluation, surgical excision was advised to prevent further growth. The lesion was excised under wrist block anesthesia through a Bruner incision, allowing full removal despite adherence to surrounding structures. Postoperative management included antibiotics, analgesics, and wound care, with regular monitoring for complications. Clinical Discussion: The anatomy of vascular malformations in the upper extremities, particularly over the hands is challenging as it requires very accurate and meticulous management due to the complexity of its anatomy and the region's functional importance. The patient's recovery was stable, and follow-up visits indicated successful wound healing without infection or recurrence. Conclusion: This case highlights the significance of thorough diagnostic workup, meticulous surgical technique, and effective postoperative management in achieving favorable outcomes for low-flow venous malformations in the hand.