Assessment of Combined Surgical Excision with Local Bleomycin Injection in the Management of Congenital Vascular Lesions

Background: Vascular malformations may cause significant deformity and dysfunction and are difficult to control because of their tendency to expand. The aim of this research was to evaluate the effectiveness of intralesional injection of bleomycin as a sclerosing agent in conjunction with surgical excision of vascular lesions for the therapy of vascular lesions. Methods: This study was an interventional one arm trial conducted on 18 patients with vascular malformation. The lesion was grossly removed surgically, without sacrificing any important structure, bleomycin was used to be injected intralesional with injection in parts adherent to vital structure. Dilution of bleomycin and amount are tailored to each patient according to size of the lesion and total body weight. Results: the median age of the studied patients was 3.5 years. Nine cases (50%) were females, and nine cases (50%) were males. 14 cases had vascular anomalies in the head and neck (77.8%) while 2 cases had vascular anomalies in the back (11.1%), one case (5.6%) had vascular anomaly in the chest wall and one case was occupying abdomen and lumbar region and extending to the groin (5.6%). most of the cases were cystic hygroma 14 cases (77.8%), two cases were venous malformation (11.1%) and two cases were hemangiomas (11.1%). No cases acquired nerve injury, visceral injury, vascular injury, solid organ injury or mortality as intraoperative complications. intraoperative bleeding in (one case) and respiratory affection in (one case). Postoperatively, the most prevalent complication was edema (nine cases), partial recurrence (six cases), unsightly scar (three cases) and transient nerve affection (two cases). 11 cases (61.1%) had good response at 1st attack, while six cases (33.3%) had satisfactory response and one case (5.6%) had poor response. 15 cases (83.3%) needed single injection with excision of the lesion intraoperative, two cases (11.1%) needed 2 injections. One intraoperative and the second time percutaneously under sedation. One case (5.6%) had venous malformation and needed 7 injections of bleomycin, one injection intraoperative and six injections thereafter. 14 parents (77.8%) were completely satisfied, 3 parents (16.7%) were moderately satisfied, and one parent was unsatisfied (5.6%). Conclusion: Surgical excision combined with intralesional injection of Bleomycin as a sclerosing agent is effective as a primary strategy in management of vascular malformation with better aesthetic outcomes as demonstrated by parents’ and surgeons’ satisfaction associated with low recurrence rates and manageable complications.