[Early surgery of immature hemangiomas with the aid of an ultrasonic scalpel. Apropos of 81 cases].
BACKGROUND
The natural course of immature hemangiomas in infants is well-known. A rapid phase of growth from 6 to 8 months is followed by a period of stability then regression. Since approximately 70% of these immature hemangiomas resolve spontaneously, abstention is generally the rule. The volume or localization of certain lesions may nevertheless have a serious functional or morphological impact.


METHODS
This retrospective study included 81 children who underwent surgery between October 1994 and March 2000. The children were aged 2 to 38 months at the time of surgery. Orbital localizations predominated (33 children). The indication for surgery was based on two criteria: risk of a functional impairment or risk of morphological sequela. All children with orbital hemangiomas with a functional risk of amblyopia were initially treated with corticosteroids. Surgery was performed in case of failure. The CAVITRON was used for 77 children and DISSECTRON for 4. These two ultrasound devices allowed easy dissection with little hemorrhage.


RESULTS
There were no peroperative hemorrhagic complications. Few postoperative complications were observed. After resection of the orbital hemangiomas there was little functional impact and the postoperative ophthalmologic examinations were normal within several weeks. Mean follow-up was 12 months after surgery. Use of an ultrasound dissector allowed early and safe treatment of immature hemangiomas.


CONCLUSIONS
Certain voluminous or poorly localized hemangiomas, particularly on the face, can have a serious function, morphological or psychological impact. Medical treatment is not always active and surgical resection may be required before the development of definitive sequelae. Ultrasound dissection, not previously used in this indication, can contribute significantly to the surgical outcome as demonstrated in these children operated on early. This technique is safe and shortens operative time. In light of these results, we believe early resection of immature hemangiomas should be reevaluated. It should not be considered as a last resort but rather as a complementary treatment.
Picard
A
A
Service de Chirurgie Maxillo-Faciale, CHU Trousseau, 37044 Tours.
Soupre
V
V
Diner
P A
PA
Buis
J
J
Goga
D
D
Vazquez
M P
MP
D000367:Age Factors; D000550:Amblyopia / Q000209:etiology / Q000517:prevention & control; D002675:Child, Preschool; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control; D005153:Facial Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006391:Hemangioma / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014464:Ultrasonic Therapy / Q000295:instrumentation*
Chirurgie précoce des hémangiomes immatures à l'aide d'un dissecteur à ultrasons. Etude à propos de 81 cas.