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. 2025 Mar 1;155(3):539-546.
doi: 10.1097/PRS.0000000000011532. Epub 2024 May 13.

Has Propranolol Eradicated the Need for Surgery in the Management of Infantile Hemangioma?

Julien Coulie  1   2   3 , Valérie Dekeuleneer  1   2   3 , Alexander Gerdom  2 , Mieke Roggen  1   4   3 , Anne-Christine Bataille  1   2   3 , Stéphane Moniotte  1   4   3 , Maude Coyette  4 , An-Katrien De Roo  1   5   3 , Laurence M Boon  1   2   6   3
Affiliations

Has Propranolol Eradicated the Need for Surgery in the Management of Infantile Hemangioma?

Julien Coulie et al. Plast Reconstr Surg. .

Abstract

Background: The authors assessed the impact of propranolol as the first-line treatment of infantile hemangioma (IH) on the need for surgery in the management of IH.

Methods: In this retrospective study, 420 patients with IH referred to a multidisciplinary center between January of 2005 and August of 2014 were included. Clinical data, including sex; age at first consultation and at treatment initiation; location, size, number, aspect, and complications of IH; and type of treatment were collected. Statistical analyses were conducted considering each patient and each tumor independently.

Results: A total of 625 IHs (420 patients) were reviewed; 113 patients had more than 1 IH (26.91%). Median age at first consultation was 7 months. Overall, 243 patients were treated (57.86%) using surgery ( n = 128 patients, 141 IHs), propranolol ( n = 79 patients, 89 IHs), corticosteroids ( n = 51 patients, 56 IHs), or laser ( n = 34 patients, 36 IHs). Propranolol was effective in all but 2 infants with IH. Seven of 79 patients (8.86%) initially treated with propranolol still required surgery, in contrast to 18 of 51 patients (35.29%) initially treated with corticosteroids and 103 of 290 patients (35.51%) with no medical treatment. Since the availability of propranolol, patients were less likely to undergo surgery (48 versus 80 patients; P < 0.001). This demonstrated that the use of propranolol reduced the need for surgery ( P < 0.001; OR, 0.177; 95% CI, 0.079 to 0.396).

Conclusions: Propranolol dramatically reduced the need for surgery, regarding indications and number of patients. Surgical correction remains important for sequelae management, nonresponders, or strawberry-like IH.

Clinical question/level of evidence: Risk, III.

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