الفهرس | Only 14 pages are availabe for public view |
Abstract Venous malformation (VM) is the most common form of vascular malformation, which affects approximately 1% of the population. VM affects different anatomic regions of the body and different types of tissues, with variable presenting symptoms including swelling/contour deformity, skin discolouration and pain. Venous malformations remain a challenging clinical entity to diagnose and treat. They have been treated by a variety of modalities, including surgery, various forms of sclerotherapy, laser therapy and other modalities as radiofrequency ablation and electrochemical treatment or a combination of these methods. The choice of treatment should therefore be individualized based on several factors such as the depth, extent, and anatomical location of the lesion. Because many venous malformations are not fully resectable, sclerotherapy has emerged as the primary treatment option for venous malformations). Sclerotherapy involves the injection of a sclerosant into the malformation, which causes cellular destruction, thrombosis, and intense inflammation and scarring leads to shrinkage of the lesion. Sclerotherapy is a generally safe, less invasive, costeffective, and practical technique for the treatment of VMs,and several studies have documented reduction in the size of the malformation and improvement in pain. Interstitial Nd-YAG laser coagulation is another effective and minimally invasive method for treating venous malformations and is an alternative or complimentary to other therapies, the mechanism of this treatment is to reduce bulk and hypervascularisation and improve contour and function. Venous malformations, although benign lesions, can present a diagnostic and management challenge. Although the different therapeutic options have been described to date their individual relevance has still to be defined. Due to absence of clear studies comparing different treatment modalities especially between interstitial laser and sclerotherapy, so our comparative study between sclerotherapy and Nd:YAG interstitial laser in the treatment of venous malformations is unique study. Our study was done to compare effectiveness of bleomycin Sclerotherapy and Nd:YAG interstitial laser in the treatment of venous malformation by using subjective clinical assessment and objective changes on MR imaging. This was the first study with no previous studies conducted to compare this effectiveness. Study occurred at plastic surgery department in Ain Shams University hospitals between June 2015 to June 2018. It included 30 patients of all age groups of both sex, with venous malformation. Patients were divided into two groups I and II. group I included15 patients with were treated by bleomycin sclerotherapy and groups II treated by Nd:YAG interstitial laser. Complications in our study in comparison to other studies were minimal and there was no major complications occurred in both groups. In our study, there was significant improvement and complete response in (73.3%) of patients treated by bleomycin sclerotherapy In group I, we found significant improvement in lesion size in cm^2 (5.76±3.42), moderate improvement in lesion size (13.46±2.83) and mild improvement in lesion size (15.49±0.00). Also, we found significant improvement in infiltrating type of venous malformation (81.8%). In group II, we found that mild improvement in (53.3%) of patients and moderate improvement in (46.7%) In group II, we found moderate improvement in lesion size (4.31±2.09) and mild improvement in lesion size (11.31±3.18).also moderate improvement occurred with average (81.95±38.44) Joule/cm2 while mild improvement occurred with average (50.95±15.91). Also, we found mild improvement in infiltrating type of venous malformation. |