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.

Download file

Counter downloads: 385

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

References

Банин В.В., Шафранов В.В., Фомина Л.В. и др. Ультраструктурная характеристика развития истинных гемангиом и их лечение у детей // Детская хирургия. - 1998. - № 4. - С. 35-41.

Беляев М.К., Федоров К.К. Оправдана ли выжидательная тактика при гемангиомах наружной локализации у детей? // Рос. вестн. детской хирургии, анестезиологии и реаниматологии. - 2014. - Т. 4, № 1. - С. 8-15.

Буторина А.В., Шафранов В.В. Современное лечение гемангиом у детей // Лечащий врач. - 1999. - № 5. - С. 61-64. № 1 (60) март’2017 Вопросы реконструктивной и пластической хирургии Пластическая хирургия 15

Васильев И.С., Абушкин И.А., Диомидов И.А., Лапин В.О. Аномалии развития сосудов: терминология, классификация // Вестник ЮУрГУ. - 2013. - № 13 (3). - С. 66-69.

Иванов А.В., Политова О.И., Колесников К.Л., Корнильев М.Н., Топольницкий О.З., Васильев А.Ю. Диагностика патологии периферических кровеносных сосудов челюстно-лицевой области у детей // Лечение и профилактика. - 2015. - № 1 (13). - С. 66-73.

Исаков Ю.Ф. Хирургические болезни у детей. - М.: Медицина, 1993. - 576 с.

Мельник Д.Д. Криолечение гемангиом с использованием устройств из никелида титана: дис. … д-ра мед. наук. - Томск, 2000.

Терновский С.Д. Ангиомы // Хирургия детского возраста. - М.: Медгиз, 1959. - С. 179-186.

Федореев Г.А. Гемангиомы кожи у детей. - М., 1971. - 192 с.

Шафранов В.В., Буторина А.В. Спонтанный регресс гемангиом у детей // Врач. - 1997. - № 4. - С. 16-17.

Amir J., Metzker A., Krikler R., Reisner S.H. Strawberry hemangioma in preterm infants. // Pediatr. Dermatol. - 1986. - 3. - P. 331-332.

Burns A.J., Navarro J.A., Cooner R.D. Classification of vascular anomalies and the comprehensive treatment of hemangiomas // Plast. Reconstr. Surg. - 2009. - V. 124, № 1S, - P. 69e-81e.

Hassanein A.H., Mulliken J.В., Fishman S.J., Greene A.K. Evaluation of terminology for vascular anomalies in current literature // Plast. Reconstr. Surg. - 2011.

Holmdahl K. Cutaneous hemangiomas in premature and mature infants // Acta Paediatr. - 1955. - 44. - P. 370.

Hoornweg M.J., Smeulders M.J.C., Ubbink D.T., van der Horst C.M.A.M. The prevalence and risk factors of infantile haemangiomas: A case-control study in the Dutch population // Paediatr. Perinat. Epidemiol. - 2012. -26. - P. 156.

Jacobs A.H., Walton R.G. The incidence of birthmarks in the neonate // Pediatrics. - 1976. - 58. - P. 218.

Janis J.I. Essentials of plastic surgery // John L.B. Vascular anomalies. - St. Louis, Missouri, 2007. - P. 138-143.

Marler J.J., Mulliken J.B. Current management of hemangiomas and vascular malformations // Plast. Reconstr. Surg. - 2006.

Michel Wassef, Francine Blei et al. Vascular Anomalies Classification: Recommendations from the International Society for the Study of Vascular Anomalies // Pediatrics. - 2015. July - V. 136, № 1, Special Topic. P. 1-12.

Mulliken& Young’s Vascular Anomalies Hemangiomas and Malformations // John B. Mulliken, Patricia E. Burrows, Steven J. Fishman. - 2nd ed. - NY, Oxford University Press, 2013. - 1118 p.

Mulliken J.B., Glowacki J. Hemangiomas and vascular malformations in infants and children: A classification based on endothelial characteristics // Plast. Reconstr. Surg. - 1982. - № 69. - P. 412-422.