INTRODUCTION: Infantile hemangioma is the most common benign neoplasm of infancy.1 Treatment varies according to size, location, local complications, and evolutive stage.2 Surgical treatment in the active phases was considered one of the main options. Since 2009, the use of β-blockers for treatment of patients with infantile hemangioma was scientifically supported. Simultaneously with the favorable results obtained, doubts about the impact on surgical indication arose. To date, there are limited data discussing these changes in surgical practice. Therefore, this study intends to answer important questions from plastic surgeons all over the world regarding the surgical management of infantile hemangiomas:
- Has the number of procedures reduced?
- Have the surgeries been delayed?
- Have the procedures been less complex?
PURPOSE STATEMENT: Compare management of patients with infantile hemangioma before and after the introduction of β-blockers and assess whether pharmacologic therapy changed surgical treatment in terms of number of cases operated, magnitude of the procedure, and timing of surgery.
MATERIALS AND METHODS: A retrospective cohort study was accomplished, including 278 patients with infantile hemangioma followed between 1998 and 2016. Patients with active (noninvoluted) infantile hemangioma without urgent indication of treatment and with lesions in relevant anatomical sites (around eyelids, nose, mouth), with cosmetic deformities, local complications, and partially obstructed orifices were evaluated. A number of 136 patients met the inclusion criteria and were divided into 2 groups, treated before 2009 (n = 67, before the introduction of β-blockers) and after 2009 (n = 69, already including patients treated with propranolol).
RESULTS: In the first group (before 2009), surgery was the only treatment for 21 (31.3%) patients. From the remaining 46, surgery was combined with clinical treatment in 23 (corticosteroids, lasers), totalizing 44 (65.7%) patients treated by surgery. Surgical rate per patient was 1.47, and surgery duration per patient was 112.4 minutes. In the second group (after 2009), surgery was the single treatment in only 2 patients (2.9%). From the remaining 67, surgery was combined with clinical treatment in 14, totalizing 16 (23.2%) patients treated by surgery. Surgical rate per patient was 1.12, and surgery duration per patient was 71.9 minutes. There was a marked reduction of 64.7% on the number of patients who underwent surgery and a decrease of 23.8% on the number of surgeries per patient.
CONCLUSIONS: Overall, there was an impact on the total number of surgeries and its complexity, allowing a new perspective on the surgical and clinical management of infantile hemangiomas. β-Blockers are recommended for exclusive clinical treatment for infantile hemangioma given its clinical safety, low cost, and proven efficacy. It seems that the use of β-blocker can be the best pharmacologic choice and a neoadjuvant indication to reduce the lesion to facilitate resection and postpone surgery.
1. Boye E, Masatoshi J, Olsen B. Infantile hemangioma: challenges, new insights, and therapeutic promise. J Craniofac Surg. 2009;20:1–7.
2. Frieden IJ, Einchenfield LF, Esterly NB, et al. Guidelines of care for hemangiomas of infancy. J Am Acad Dermatol. 1997;37:631–637.