Sclerotherapy of infantile hemangiomas (a clinical and experimental study)

BACKGROUND: Infantile hemangiomas are characterized by a wide variety of clinical presentations, locations, and extents; however, treatment efficacy remains limited. In recent years, a form of phlebosclerotherapy using a sclerosant in the form of fine foam has been increasingly applied in clinical phlebology. AIM: The work aimed to develop a technique and algorithm for sclerotherapy of infantile hemangiomas using lauromacrogol 400 and to evaluate the safety of this detergent in a morphological model. METHODS: The effect of the detergent was studied in an experimental model using the combs of Zagorsk Salmon chickens (n = 12). The detergent was administered in different volumes (1.0 mL, 1.5 mL, and 2.0 mL) using a multipuncture technique (0.1 mL per needle injection). The second stage of the study included clinical observations of children with infantile hemangiomas (n = 23). Lauromacrogol 400 solution was administered intralesionally in an individually calculated volume under ultrasound guidance after infiltration of the hemangioma base with ropivacaine solution. RESULTS: A technique and algorithm for sclerosant administration in infantile hemangiomas were developed based on the evaluation of its effects on the vascular network and skin in the chicken comb model. Clinical and morphological data were obtained on the effects of high and low sclerosant doses on hemodynamics and skin structure in the experimental model. The ratio of vascular mass between infantile hemangiomas in the proliferative stage and the experimental model was calculated. A two-stage procedural approach was proposed, consisting of sequential administration of an anesthetic followed by a sclerosant into infantile hemangiomas. Clinical resolution was achieved in 82.6% of children, and clinical improvement was observed in 17.4%. CONCLUSION: A highly effective method for treating children with infantile hemangiomas was developed. Experimental findings enabled evaluation of the trends of clinical and morphological changes induced by the sclerosant and determination of its optimal concentration. The results of the study prevented complications and adverse cosmetic outcomes.