DIFFERENTIATED APPROACH TO THE TREATMENT OF PATIENTS HAVING INFANT HEMANGIOMAS OF EXTERIOR LOCALIZATONS | Issues of reconstructive and plastic surgery. 2017. № 1 (60). DOI: 10.17223/1814147/60/01

DIFFERENTIATED APPROACH TO THE TREATMENT OF PATIENTS HAVING INFANT HEMANGIOMAS OF EXTERIOR LOCALIZATONS

The aim of this study was to optimize treatment approaches for patients having infant hemangiomas (IH). Material and methods. A retrospective data analysis of 9723 patients having IH was performed using collection of anamnesis, clinical observation with photodocumenting of vascular neoplasms in dynamics, laboratory Вопросы реконструктивной и пластической хирургии № 1 (60) март’2017 Васильев И.С., Васильев С.А., Абушкин И.А. и др. methods of investigations based upon ISSVA classification. Patients having local tumors (n = 8045, 82.7%) were observed in dynamics. The rest of 1678 (17.3%) children were divided into 4 groups depending on treatment method: group one (n = 386) received intratissue glucocorticosteroid therapy; group two (n = 705) received laser thermotherapy; group three (n = 275) received enteral propranolol; group four (n = 312) received enteral propranolol in combination with laser thermotherapy or surgical treatment. Results. Dynamic observation is an optimal method of managing patients having local non-complicated IH (82.7%). Indications for active treatment were: localization of tumors in functional and aestheticzones, large volume, rapid growth, bleeding and ulceration of hemangiomas. Excellent and good aesthetic treatment results of localized complicated tumors demonstrated intratissue injection of glucocorticosteroids or laser thermotherapy. Treatment of multiple, rapidly proliferating large IHs using laser thermotherapy was effective but needed repeated procedures in 25% of patients. Monotherapy with beta-blockers in a dose of (1.70 ± 0.19) mg/kg resulted in good therapeutic effect in most cases but sometimes needed drug removal due to side effects. Combination of betablockers or laser therapy allowed to decrease dose and duration of propranolol therapy (p = 0.001) and number of repeated procedures of laser thermotherapy (p = 0.01) compared to their monotherapy. Conclusion. Key factor in adequate diagnosis and treatment of vascular anomalies is using ISSVA nomenclature. Most (82.7%) of IH undergo spontaneous involution and do not need any treatment. Treatment of “problem” IH should be differentiated one.

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Keywords

младенческая гемангиома, сосудистые аномалии, ангиодисплазии, сосудистые мальформации, классификация, терминология, номенклатура, лечение, лазерная термотерапия, пропранолол, infant hemangioma, vascular anomalies, vascular malformation, laser thermotherapy, propranolol pharmacotherapy, treatment, classification, terminology, nomenclature

Authors

Name	Organization	E-mail
Vasilyev I.S.		igorvasilyev@list.ru
Vasilyev S.A.
Abushkin I.A.
Vasilyev Yu. S.
Vasilyev V.S.
Karpov I.A.
Denis A.G.
Sudeikina O.A.
Lapin V.O.
Romanova O.A.

Всего: 10

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