Diode laser and surgical treatment of giant cavernous hemangioma of the body surface

PURPOSE : 
The efficacy of Diode laser and surgical treatment of giant cavernous hemangioma of the body surface

METHODS: 
2005 ~ 2007, 18 cases of giant cavernous hemangioma of the body surface were treated. First fiber optic percutaneous insertion of vascular tumors and the outer edge of the deep burning, pressure bandage to be tumor thrombosis after surgery.

RESULTS: 
18 cases were cured and no recurrence during follow-up

CONCLUSION: 
Laser and surgical treatment of giant hemangioma of the bodysurface, less bleeding, recurrence rate is low, less complications and curative effect for the treatment of cavernous hemangioma provides a new way.

[Key words] Diode ; laser; Hemangioma; cavernous; thrombosis

Body surface hemangioma is a congenital vascular malformation. That the existence of the disease at birth, growth and expansion of age. The clinical surgery, laser, injection sclerotherapy, frozen and other treatment. Cavernous hemangioma lesion a wide range of rich blood supply, blood vessels tortuous thin wall, surgical separation easy bleeding. Radical surgery can achieve results, but part of the giant hemangioma, often due to blood loss volume, and the surrounding ill-defined but not removed completely, bleeding, skin flap necrosis and other complications occurred and postoperative recovery fat chance of a larger. Laser Treatment of Superficial Hemangioma alone although trauma, no incision scar, but because of their often cause local aseptic inflammation, thrombosis and its surrounding adhesions, there
subcutaneous induration, pain, does not apply to large hemangioma, and the high recurrence rate. In recent years, our department applied laser and surgical treatment of giant hemangioma surface made remarkable curative effect, the information will now be summarized as follows.


1 Clinical
1.1 General Information: April 2005 ~ May 2007, with laser and surgical treatment of giant cavernous hemangioma of the body surface in 18 cases, 8 males and 10 females, aged from 20 to 65 years old. Lesions, shoulder in 2 cases, 3 cases of abdominal wall, back in 3 cases, limbs in 7 cases, the hip in 2 cases, the perineum 1cases. 8 patients have been outside the hospital for 1 ~ 2 times surgery. 1 case had been sclerotherapy. Extent of the lesion 5 cm × 6
cm ~ 30 cm × 40 cm, an average of 10 cm × 13 cm.

1.2 Treatment Methods: Diode laser system 30W, wavelength 810nm, fiber diameter of 0. 6 mm, can be selected continuous or pulse output. According to lesion choose epidural, brachial plexus, or local anesthesia. Conventional disinfection shop towel, with 5 casing needle deep into the tumor, see the return of blood after the tumor deep into the fiber to 15 W / s power, while back side burning fiber. Laser adopt the "multi-point radial" puncture burning, to avoid harming the skin's surface and around the major nerves, tendons, or blood vessels. Intraoperative consuming 3 000 ~ 10 000 J. Postoperative local pressure dressing, hemostatic drugs used to promote thrombosis, applied 3 d of antibiotics to prevent infection. Most occur in patients with moderate fever, thrombosis due to consider. 5 d after the tumor shrink, harden, compressibility weakened. Surgical resection, patients can see a large number of bodiesfound in tumor thrombosis (confirmed by pathology), Bleeding decreasedm significantly
.
1.3 Results: 18 cases were stage Ⅰ, all been healed incision, no physical dysfunction, or bleeding and other complications after a follow-up to 36 months without recurrence.

2 Discussion
The Diode laser and surgical treatment of superficial cavernous hemangioma is the emiconductor laser into the tumor tissue, the laser can be vascular malformations in a large number of highly selective absorption of the reduced hemoglobin, while the other organizations to absorb very little, so the laser energy mainly in the lesion within the solar energy to heat means acting on the blood vessels within the cortex, resulting in selective destruction of the role of coagulation. In addition intravascular hemoglobin absorption of the laser, can cause intravascular thrombosis, blood vessel wall injury, vascular closure.
After pressure after 5 d, the promotion of thrombosis, significantly reduced the amount of surgical bleeding. After all, after two anesthesia,So, apply only to large hemangioma is estimated that surgical patients with large amount of bleeding. This paper reports 18 cases of the range, and distributed in various parts of the body surface of cavernous hemangioma, combined with laser surgery, has received satisfactory results.


This method requires attention to a few points, 
A. Do not burn the skin away from too close and easy to cause skin burns. 
B. To avoid the near important nerves and large blood vessels and tendons. 
C. Power is too low, incomplete vascular coagulation easy bleeding, power is too high, skin damage is too large. Typically 15 W / s. 
D. Attention to puncture the direction and strength, or else make the first break in the optical fiber within the hemangioma.

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