Lisa R David1, Marc M Malek, Louis C Argenta. 1. Department of Plastic and Reconstructive Surgery, Baptist Medical Center, Wake Forest University, Medical Center Blvd, Winston-Salem, NC 27157-1075, USA. ldavid@wfubmc.edu
Abstract
BACKGROUND: Haemangiomas are common vascular lesions occurring in up to 10-12% of infants by 1 year of age. Typically, these lesions are treated expectantly unless complicated by haemorrhage, ulceration, infection, or compromise of adjacent vital structures. Ulceration is a particularly difficult problem because of associated pain, infection, haemorrhage, and subsequent scarring. MATERIALS AND METHODS: Seventy-eight children (54 girls, 24 boys) with ulcerated haemangiomas, from our vascular malformation clinic were enrolled in a prospective pulse dye laser treatment protocol from April of 1995 to November of 2001. The mean size of the ulcerated haemangiomas requiring treatment was 21 cm2. Lesions were treated with minimal debridement and the Cynosure pulse dye laser with a mean energy of 6.6 J, and a mean number of 173 pulses per treatment. Lesions were treated in a sequential pattern at 3-4 week intervals until cutaneous healing or involution of the haemangioma occurred. RESULTS: Seventy-one of the 78 patients (91%) responded to laser therapy alone with a mean number of 2.0 treatments. Six patients with very large haemangiomas required oral steroids (2-3 mg/kg/day) in combination with the pulse dye laser. After failing to improve on steroid therapy, two patients required the addition of interferon to their treatment protocol. The mean follow up time is 15 months with no sign of recurrent ulceration or regrowth of the haemangiomas in our study population. SUMMARY: Pulse dye laser therapy is a reasonably effective means of resolving the untoward complication of ulceration of haemangiomas. We report the largest series to date of ulcerated haemangiomas treated with this modality.
BACKGROUND: Haemangiomas are common vascular lesions occurring in up to 10-12% of infants by 1 year of age. Typically, these lesions are treated expectantly unless complicated by haemorrhage, ulceration, infection, or compromise of adjacent vital structures. Ulceration is a particularly difficult problem because of associated pain, infection, haemorrhage, and subsequent scarring. MATERIALS AND METHODS: Seventy-eight children (54 girls, 24 boys) with ulcerated haemangiomas, from our vascular malformation clinic were enrolled in a prospective pulse dye laser treatment protocol from April of 1995 to November of 2001. The mean size of the ulcerated haemangiomas requiring treatment was 21 cm2. Lesions were treated with minimal debridement and the Cynosure pulse dye laser with a mean energy of 6.6 J, and a mean number of 173 pulses per treatment. Lesions were treated in a sequential pattern at 3-4 week intervals until cutaneous healing or involution of the haemangioma occurred. RESULTS: Seventy-one of the 78 patients (91%) responded to laser therapy alone with a mean number of 2.0 treatments. Six patients with very large haemangiomas required oral steroids (2-3 mg/kg/day) in combination with the pulse dye laser. After failing to improve on steroid therapy, two patients required the addition of interferon to their treatment protocol. The mean follow up time is 15 months with no sign of recurrent ulceration or regrowth of the haemangiomas in our study population. SUMMARY: Pulse dye laser therapy is a reasonably effective means of resolving the untoward complication of ulceration of haemangiomas. We report the largest series to date of ulcerated haemangiomas treated with this modality.