We investigated the effect of microsurgical technique after resection of cavernous hemangioma of the upper extremity. Methods From October 2005 to August 2007, 4 cases of cavernous hemangioma of the palm, 3 cases of the forearm and 1 case of the finger were resected by microsurgical techniques, and the recurrence rate and functional effects were followed up. The results showed that the 8 cases were followed up from 14 months to 36 months after surgery. No recurrence was observed. Both the upper limb and hand function recovered well. Conclusion In cavernous hemangioma of the upper extremity, microsurgical techniques can be used to identify the boundaries of the tumor well, achieve complete resection, and reduce the recurrence of hemangioma. Hemangioma; microsurgical technique; recurrence Spongiform hemangioma is a benign tumor that can occur in any part of the body and often has unclear borders. From October 2005 to August 2007, we used microsurgery technique to remove cavernous hemangioma in the palm of hand, 3 cases in forearm and 1 case in finger. 1, data and methods 1.1 General data: There were 8 cases in this group, 3 males and 5 females; the youngest was 4 years old, the oldest was 59 years old, and the average was 20.8 years old. All of them were found unintentionally. The duration of the disease was as short as 1 year and as long as 21 years, with an average of 6.2 years. The tumor was limited to skin and subcutaneous tissues in 3 cases and involved tendons, joint capsule, blood vessels and nerves in 5 cases, including 1 case in which the tumor grew into bone tissue. 2.2 Surgical method: In this group of 8 cases, brachial plexus anesthesia was used, among which 2 cases were combined with ketamine intravenous anesthesia, and the upper limb was not expelled with a balloon tourniquet, and an incision was made according to the long axis of the tumor, and the incision was made through the area where the hemangioma infiltrated the skin (where the purple color on the skin was particularly obvious). The incision on the finger and palm is “Z” shaped, avoiding perpendicular intersection with the transverse finger and palm. The tumor is cut to the surface of the tumor, and under the microscope, the hemangioma is distinguished from the normal vascular tissue, and the tumor is carefully peeled off under the skin dermis using non-invasive techniques, with special attention to ligating the proximal major input vessels at the normal vascular tissue, patiently peeling off the tumor tissue surrounding the nerves, and avoiding excessive damage to the peritendinous tissue and joint capsule. The skin infiltrated by the tumor and the loose incision margin were excised, the incision was closed, and the skin was drained and wrapped with a cotton pad under pressure. The incision was sutured, and the skin was drained with cotton pads. The incision was healed in one stage, and the scar tissue of forearm and hand was softened after three months of hot compress and massage. The remaining three cases recovered good function of the joints of the palm after functional exercise. At present, there are many methods to treat cavernous hemangioma, including sclerotherapy injection or embolization, YAG or CO2 laser, compression, freezing, hormone, pinyamycin injection and copper needle placement, but the results are not satisfactory and some of them have unpredictable side effects. Complete surgical removal of cavernous hemangioma has been the safer and more effective method. However, conventional surgery does not operate under a microscope and often fails to completely remove the tumor tissue for fear of damaging the vascular nerves, tendons and joint capsule, thus resulting in a high recurrence rate. If the tumor is located in the superficial part of the limb and is widespread, it can be reduced by non-surgical methods and then completely removed by surgery; however, if the tumor is located in the fingers and palm, especially if the tumor involves tendons, joint capsule, blood vessels and nerves, sclerotherapy injection or embolization, freezing, pinyamycin injection and copper needle retention should be used carefully to avoid damaging tendons, joint capsule, blood vessels and nerves and affecting hand function. Among the 8 cases operated by the author, there was a 12-year-old child with cavernous hemangioma of the palm, which had widely invaded the joint capsule, several tendons and vascular nerves. After patient and careful sharp debridement of the tumor, not only the good shape and function of the hand were preserved, but also there was no recurrence in 36 months of follow-up. 3.1 Characteristics of upper limb cavernous hemangioma The forearm and hand are often exposed, and once the tumor appears, it is easy to detect, therefore, the tumor is usually small. The hand has sensitive sensation, flexible movement and few soft tissues, and often has local distension or discomfort, and is more willing to seek medical consultation. 3.2 Necessity of applying microsurgical techniques to remove tumors Different soft tissue tumors of the hand, the recurrence rate of hemangioma after resection by traditional surgical methods is 19.3% [1], Yang Yanjun [2] et al. used microsurgical techniques to remove hemangioma of the hand, and the recurrence rate was 8.7%, and they analyzed that the reasons for recurrence may be: multiple tumors in the same area were not completely removed or the tumor envelope ruptured to cause tumor cell implantation. They analyzed that recurrence might be due to the incomplete resection of multiple tumors in the same area or the implantation of tumor cells due to the rupture of tumor envelope, or the incomplete resection of hand tissue to preserve normal tissues and structures. In the author’s opinion, the main reasons are: unclear boundary of hemangioma under the naked eye and incomplete excision of the invading tissues in the hand to preserve normal tissues and structures. Spongiform hemangioma is not a real tumor, but a vascular malformation, which is a mass of disorganized veins and vessels, named because of its sponge-like profile. The use of microsurgery technology allows for clearer judgment of the tumor and surrounding tissues, clearer differentiation between malformed and normal vessels, more complete removal of the tumor, and less recurrence, while avoiding damage to surrounding tissues such as nerves and blood vessels, tendons and joint capsules, and preventing hand function from being affected by medically induced injury. The microsurgery technique is the best choice, especially when the tumor encircles the above-mentioned tissues. 3.3 Precautions 3.3.1 The hand is an important organ for all human labor, and patients generally have high functional requirements and often have no major preoperative functional effects, which are more difficult to accept if postoperative hand function is affected. In particular, we must communicate with patients and their relatives, give a truthful and objective account of their condition and possible accidents and complications, and obtain their understanding and support before surgery, so as to avoid the risk of affecting the function of the hand during surgery. The patient should not give up the complete removal of the tumor at one time for fear of affecting the hand function. 3.3.2 Good microsurgical technique is the guarantee to reduce surgical re-trauma, especially when the hemangioma has grown on the outer membrane of the nerve or the outer membrane of the main artery, it is necessary to patiently excise the infiltrated nerve and the outer membrane of the artery under 10 times microscope, and protect the nerve bundle and the main artery so as not to affect the function of the limb. 3.3.3 After resection of cavernous hemangioma, a tourniquet should be loosened to stop bleeding adequately. If there is still more venous blood leaking from the wound surface, it is likely that the resection of the tumor is incomplete, and another microscopic resection is needed; part of the lumen often remains after resection of the tumor, and in order to avoid the formation of hematoma, a skin piece should be placed for drainage and pressure bandage. 3.3.4 Pay attention to the exercise of hand function after surgery. A systematic postoperative rehabilitation training program should be carried out with early guidance, which can be supplemented with physical therapy to maximize the patient’s enthusiasm and restore the full function of the upper limbs and hands after tumor resection.