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Management of hemangioma of infancy: review of 245 patients
B M Achauer1, C J Chang, V M Vander Kam
1Division of Plastic and Reconstructive Surgery, University of California, Irvine Medical Center, Calif., USA.
Insights
This study analyzed 299 hemangiomas in 245 patients, finding laser therapy superior to observation for improving hemangioma volume and texture. Treatment outcomes varied significantly across different management groups.
Area of Science:
- Dermatology
- Pediatric Surgery
- Medical Research
Background:
- Hemangiomas are common vascular tumors, particularly in infants.
- Previous research indicates a higher prevalence in females, but this study observed a 1:1 sex ratio in premature neonates.
- Complications include obstruction, ulceration, bleeding, infection, and pain.
Purpose of the Study:
- To evaluate the efficacy of different treatment modalities for hemangiomas.
- To compare outcomes across five distinct patient management groups: observation, steroid treatment, excision and reconstruction, laser therapy, and combined therapy.
- To analyze complications and treatment durations associated with each management approach.
Main Methods:
- A retrospective analysis of 245 patients with 299 hemangiomas treated between May 1981 and April 1994.
- Patients were categorized into five groups based on clinical management: observation, steroid treatment, excision, laser therapy, and combined therapy.
- Outcomes were assessed using a scale for improvement in volume, color, and texture, with statistical analysis via the Irwin-Fisher test.
Main Results:
- Laser therapy demonstrated statistically significant superiority over observation in improving hemangioma volume and texture, and reduced treatment length (p < 0.05).
- Significant differences in outcomes were observed between the various treatment groups.
- Complications varied, with obstruction (28.6%) and ulceration (20.4%) being most frequent.
Conclusions:
- Treatment outcomes for hemangiomas differ significantly based on the management strategy employed.
- Laser therapy presents a statistically advantageous option compared to observation for specific hemangioma characteristics.
- Further research into optimizing hemangioma treatment protocols is warranted based on these findings.
Abstract:
A retrospective study of patients treated from May of 1981 to April of 1994 was conducted. A total of 245 patients with 299 hemangiomas were studied, which represents the largest series reported to date. The study consisted of 173 females and 72 males ranging in age from 1 day to 59 years, with the average age being 4 years and 7 months. Twenty-six were premature neonates (14 females and 12 males). An interesting finding was a 1:1 sex ratio among this group in contrast to the 3:1 female-male ratio frequently reported in the literature. Onset was at birth in 170, within the first month in 43, and after the age of 1 month in 32 patients. Among the 245 patients, 175 hemangiomas were located on the head and neck, 62 on the trunk, 49 on the extremities, and 13 in the perineal area. Five groups of patients were defined based on clinical management. As a result, these groups are not similar. The five groups are as follows: group I (48), observation; group II (9), steroid treatment; group III (27), excision and reconstruction; group IV (88), laser therapy; and group V (73), combined therapy. The involved area of hemangioma was as follows: group 1, 0.5 x 0.5 to 20 x 8 cm; group II, 2 x 2 to 8 x 8 cm; group III, 0.4 x 0.8 to 7 x 7 cm; group IV, 0.5 x 0.5 to 20 x 9 cm; and group V, 1.5 x 1.5 to 25 x 25 cm. The complications of hemangioma seen at the time of consultation were obstruction (28.6 percent), ulceration (20.4 percent), bleeding (14.7 percent), infection (4.9 percent), and pain (0.4 percent). Treatment periods ranged from 1 month to 11 years, with the mean period in each group as follows: group I, 4 years and 9 months; group II, 2 years and 5 months; group III, 1 year and 1 month; group IV, 2 years and 1 month; and group V, 3 years. The outcomes of each patient were evaluated based on improvement of volume, color, and texture by the following scale: 1, poor (0 to 25 percent); 2, fair (26 to 50 percent); 3, good (51 to 75 percent); and 4, excellent (76 to 100 percent). Each of these parameters was summarized for each of the five groups. Statistical analysis by the Irwin-Fisher test was used for analysis and comparison of the final results between groups. Statistically significant differences in outcomes between treatment groups were demonstrated. Laser therapy was shown to be statistically superior to observation with regard to length of treatment and with regard to outcomes of volume and texture (p < 0.05).