Long term follow-up of intralesional laser photocoagulation (ILP) for hemangioma patients

Abstract

Background and objectives: Hemangiomas remain a challenge for patients and plastic surgeons. Promising results have been reported using intralesional photocoagulation (ILP) for treatment. The objective of our study is to review the long term results of a large series of hemangiomas in patients treated by ILP. Materials (Subjects) and Methods: A retrospective review of 684 hemangiomas in patients were treated by ILP with an Nd:YAG (neodymium-yttrium-aluminium-garnet) (1064 nm) laser over a period of 10 years (January 1996-January 2005). Patients' ages ranged from one month to 11 years 5 months (mean, 1 year 10 months). The patient group consisted of 474 females and 210 males.

Results: Patients were treated with an Nd:YAG laser delivered through a 600 m optical fiber. Laser power was set at 7 to 15 watts (W) and delivered with pulse duration of 7 to 15 seconds (s). The results showed 603 (88.6%) patients had more than 50% reduction of the volume in hemangiomas at 3 months after one treatment; and 663 (96.9%) patients had more than 50% reduction of the volume at 3 months after two treatments. Patients who had continuous ILP achieved excellent results.

Conclusions: Postoperative complications have been related to photocoagulation that has been delivered too extensively or superficially, with resultant ulceration, infection, bleeding, and scarring. These complications can be avoided if this potential for harm is kept in mind.

Keywords: Hemangioma; ILP; Nd:YAG Laser; Vascular malformation; intralesional photocoagulation.

Fig. 1:

The treated area is marked with a lattice. Laser energy is delivered to each partition via an 18-gauge Angiocath® for ILP.

Fig. 2:

The histopathological findings of the damage zone in the hemangioma immediately after ILP demonstrates evaporization, carbonization, thrombogenesis, and coagulation.

Fig. 3A:

A three-month-old baby girl suffers from a proliferating hemangioma on her right periorbit, causing obstruction to her right eye.

Fig. 3B:

Preoperative MRI of patient in Fig.3A demonstrates a hemangioma involving the right orbital area.

Fig. 3C:

Significant improvement is visible in Fig.3A patient at age 4 after one ILP and reconstructive surgery.

Fig. 3D:

Postoperative image of Fig.3A patient following ILP at the age of 11.

Fig. 4A:

A two-month-old baby girl suffers from a proliferating hemangioma on her face, causing obstruction to her right eye.

Fig. 4B:

Recovery is evident in Fig.4A patient at the age of 12 after ILP.