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Noninvasive Management of Hemangioma and Vascular Malformation Using Intralesional Bleomycin Injection

Hassan, Youssef MD; Osman, Ahmed Kamal MD; Altyeb, AlMoutaz MD

doi: 10.1097/SAP.0b013e31824e298d
Reconstructive Surgery

Background Successful treatment of vascular anomalies represents a challenging problem despite using various treatments. Intralesional injection of bleomycin has been successfully used in treatment of macrocystic lymphatic malformations and hemangiomas, based specifically on a high sclerosing effect on vascular endothelium.

Methods In a prospective study of 75 patients, there were 47 women and 28 men. Their ages ranged from 3 to 35 years with a mean age of 14 years. The effectiveness of intralesional bleomycin injection in hemangiomas and vascular malformations was evaluated.

Dosage regimens used were as follows:

- In children younger than 1 year, the maximum dose per injection is limited to 0.5 to 1 mg/kg and varied according to the size of the lesion.

- In children older than 1 year and adult, a dose of 1 to 15 mg was injected intralesionally per session.

A single dose of 15 mg per session was never exceeded. The interval between each session was 3 to 4 weeks.

Results Complete resolution (cured) in 18 (24%) patients, marked improvement occurred in 35 (47%) patients, mild improvement in 14 (18.5%) patients, and no cure in 8 (10.5%) cases.

Local complications were superficial ulceration in 5 patients and hyperpigmentation in 6 patients.

Systemic complications were flu-like symptoms in 3 patients. None of the patients presented with toxic hematological effects or signs of pulmonary fibrosis and/or hypertension.

Conclusions Intralesional bleomycin injection is an effective and a safe method for treatment of hemangiomas and vascular malformations, decreasing the need for invasive primary surgery or systemic treatment in 71% of cases and decreasing the magnitude of secondary surgical procedures in cases with moderate results.

From the Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt.

Received October 22, 2011, and accepted for publication, after revision, January 30, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Ahmed Kamal Osman, MD, Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.