Surgical Therapy

Laser Therapy

Embolic Therapy

Large hemangiomas may cause high-output congestive heart failure. These lesions most commonly arise in the liver. Rarely, embolization of the feeding artery may be indicated for the initial control of heart failure while the therapeutic effects of systemic drug therapy are pending, or when drug therapy is unsuccessful. Only a subset of liver hemangiomas with large vascular shunts cause high cardiac output. Embolization has little or no role in hepatic hemangioma without heart failure.

Flashlamp pulsed-dye laser is not beneficial for nascent or proliferating hemangiomas. It penetrates only the most superficial portion of the dermis (0.75 to 1.2 mm) and leaves the majority of the lesion untreated, causing some lightening.

Moreover, a superficial IH is often the tumor that requires no treatment and involutes without a trace.

The flashlamp pulsed-dye laser has not been shown to decrease hemangioma bulk or accelerate involution.

Laser treatment can cause hypopigmentation and increase scarring by causing ulceration and partial-thickness skin loss. The flashlamp pulsed-dye laser is indicated, however, during the involuting/involuted phase to treat residual telangiectasias. One indication for laser treatment during the proliferative phase is for excision of a subglottic hemangioma with a carbon dioxide laser.

Excision of proliferating hemangioma is generally not indicated; rather, the outcome is improved when surgery is deferred until after the tumor has involuted. Removal of a hemangioma in the proliferative phase may result in massive blood loss, transfusions, and even death. However, well-localized or pedunculated lesions that are ulcerated or bleeding may be excised if the resulting scar is no worse than would be expected after excision during involution or if the scar may be hidden. Large tumor size and the presence of ulceration increase the likelihood that later reconstruction will be necessary. Occasionally, focal gastrointestinal lesions that continue to bleed despite pharmacotherapy can be removed by endoscopic ligation or bowel resection.

Ultimately, 55% of children will have residual skin changes after hemangioma involution, including excess skin, fibrofatty tissue, and hypo- or hyperpigmentation with telangiectasias. Because children become aware of their body differences by 4 years of age, removal of these residual lesions should be considered to avoid the development of low self-esteem. Ideally, resection should be postponed to the involuted phase when expanded skin and fibrofatty residuum is minimal. Circular excision of hemangioma and purse-string closure often ensures the smallest possible scar and minimal distortion of surrounding tissues.

Дата добавления: 2014-10-15