Clinical Analysis For Posttreatment Tissue Atrophy Of Hemangiomas And Vascular Malformations

Background:Clinically, Hemangiomas(HA) and vascular malformations(VM) are very common vascular disease. The incidence of the disease can reach10%in infants. With the development of medicine and people’s consciousness, the research in HA and VM has made considerable progress in many fields recently, such as etiology, pathogenesis, classification, diagnosis, clinical manifestation, treatment, complication, outcome and prognosis.The treatment options for VM and HA is varied, which include endovascular interventional embolization, sclerotherapy, laser therapy, propranolol treatment, oral steroids, operation, cryotherapy, radionuclide therapy, copper needle therapy and so on. Each of these options has its restrictions and side effects.Present intervention for hemangiomas in our hospital,which is comprehensive and personalized, gives priority to sclerotherapy, and can be supplemented by oral propranolol, laser surgery and(or) surgical resection if possible. The therapeutic regimen should be selected in accordance with the age, location, histological type, clinical staging, est.The drugs for local injection include pingyangmycin, triamcinolone acetonide (or betamethasone), and lauromacrogol.According to reports, common side effects after treatment of HA and VM include fever, loss of appetite, skin rashes, pain, necrotic ulcerations, scar deformity, atrophy of local tissues, etc. Different from other complications, however, atrophy of local tissues is mostly irreversible and permanent. This may cause disfigurement or dysfunction when it occurs in face or limbs, and no doubt brings patients significant changes of appearance and psychosocial impact.Objective:This study mainly focuses on the causes of atrophy, in order to provide guidance for incidence reduction of tissue atrophy during clinical treatment of HA. Meanwhile, it can also provide some improvement for the treatment of hemangiomas and vascular malformations.Method:Retrospective analysis of HA and VM patients between January1st,2010and December31st,2012, at burn and plastic surgery of Shandong Provincial Hospital.353patients with HA or VM are enrolled in the study, which were treated by sclerotherapy with three kinds of drugs:pingyangmycin, hormone (triamcinolone acetonide or betamethasone) and lauromacrogol. In addition, some cases also received oral propranolol, laser surgery, cryotherapy, radioactive isotopes or resection.All of these353patients were followed up for6months to3years. Fill in the form which is designed in advance with the basic information of patients, the history, symptoms and sings of disease. Pay more attention to the possible factors associated with tissue atrophy, such as gender, age, histological type, only sclerotherapy treated or not, treated with isotope or not, treated with cryotherapy or not, whether went through painful ulcerations, etc.Analysis data with the help of SPSS19.0, we can figure out the incidence of local tissue atrophy. And Concluded the risk or protected factors associated with tissue depression through the univariate and multivariate logistic regression analyses.Results:A total of353cases were enrolled in our study, include221cases of hemangiomas and132cases of vascular malformations. Among them,138cases are male and215cases are female. They are between0.07and79years old with an average age of4.82years old. The lesions can locate in any part of the body surface,206cases in head and neck,52cases in trunk,2cases in perineum,69cases in limbs, and24cases are multiple.17cases suffer tissue atrophy, include11cases of hemangiomas and6cases of vascular malformations. Among them,5cases are male and12cases are female. They are between0.24and46years old with an average age of5.03years old. The location of the lesions:8cases in head and neck,8cases in limbs, and1case in trunk. The overall incidence of tissue depression is4.82%. There were236cases treated by sclerotherapy only among the whole353cases.17cases received cryotherapy and21cases received isotope therapy except for the local injection.5of17cases with depression were simply treated by sclerotherapy. In addition to sclerotherapy,2cases also received cryotherapy and6cases accepted isotope therapy. Furthermore,5of17cases with depression came up after curation of necrosis and ulceration.univariate logistic regression analysis shows that isotope therapy, ulceration and sclerotherapy only are the factors affecting the local tissue atrophy (P<0.05). Gender, age, type, cryotherapy have no obvious relation with the occurrence of tissue atrophy (P>0.05). Followed multivariate logistic regression analysis shows that isotope therapy and necrosis are independent risk factors for tissue atrophy; sclerotherapy is a protected factor.The depression rates of necrotic and non-necrotic group are23.81%and3.61%respectively, chi-square test shows P<0.05, OR8.333, RR6.59. The depression rates of isotope therapy and non-isotope therapy group are28.57%and3.31%respectively, chi-square test shows P<0.05, OR11.673, RR8.62.Conclusion:1. Isotope therapy is one of the independent risk factors to tissue depression. As suggested, we should avoid the use of radionuclide during the treatment of hemangiomas and vascular malformations.2. Ulceration before or during the treatment is also an independent risk factor to tissue depression. As a result, early and active intervention should be taken in the cases which can not regress spontaneously. Management like dressing change is significant to ulcerated cases. Because it can improve the wound healing and reduce scars or defection of tissues.3. The combination of Pingyangmycin with betamethasone (or triamcinolone acetonide) and lauromacrogol has satisfactory effects on the treatment of HA and VM. Incidence of tissue atrophy is lower. It can be one of the main methods for intervention of hemangiomas and vascular malformations, while abide by the principles of injection and modulate the dosages.4. We never suggest rapid regression or fibrosis of proliferative hemangiomas in one or two injections. The main purpose of treatment is to control the growth of tumors, and make it degenerate gradually.