Assessment of Combined Surgical Excision with Local Bleomycin Injection in the Management of Congenital Vascular Lesions
Elsadat, A., Abdelazeem, I., Marzouk, S., Shaban, A., Abdelhafeez, A., Sayed, S. (2025). Assessment of Combined Surgical Excision with Local Bleomycin Injection in the Management of Congenital Vascular Lesions. EKB Journal Management System, 6(4), 42-61. doi: 10.21608/ejmr.2024.266130.1541
Ahmed Mohamed Elsadat; Islam Elsayed Abdelazeem; Seham Anwar Emam Marzouk; Ahmed Hassan Shaban; Abdelhafeez Mohamed Abdelhafeez; Sherief Elprince Sayed. "Assessment of Combined Surgical Excision with Local Bleomycin Injection in the Management of Congenital Vascular Lesions". EKB Journal Management System, 6, 4, 2025, 42-61. doi: 10.21608/ejmr.2024.266130.1541
Elsadat, A., Abdelazeem, I., Marzouk, S., Shaban, A., Abdelhafeez, A., Sayed, S. (2025). 'Assessment of Combined Surgical Excision with Local Bleomycin Injection in the Management of Congenital Vascular Lesions', EKB Journal Management System, 6(4), pp. 42-61. doi: 10.21608/ejmr.2024.266130.1541
Elsadat, A., Abdelazeem, I., Marzouk, S., Shaban, A., Abdelhafeez, A., Sayed, S. Assessment of Combined Surgical Excision with Local Bleomycin Injection in the Management of Congenital Vascular Lesions. EKB Journal Management System, 2025; 6(4): 42-61. doi: 10.21608/ejmr.2024.266130.1541

Assessment of Combined Surgical Excision with Local Bleomycin Injection in the Management of Congenital Vascular Lesions

Egyptian Journal of Medical Research
Volume 6, Issue 4, October 2025, Pages 42-61    PDF (712.29 K)
Document Type: Original Article
DOI: 10.21608/ejmr.2024.266130.1541
Authors
Ahmed Mohamed Elsadat1; Islam Elsayed Abdelazeem* 1; Seham Anwar Emam Marzouk1; Ahmed Hassan Shaban2; Abdelhafeez Mohamed Abdelhafeez1; Sherief Elprince Sayed1
1General surgery department, Faculty of Medicine, Beni-Suef University
2Oncology department, Faculty of Medicine, Beni-Suef University
Abstract
Background: Vascular malformations may cause significant deformity and dysfunction and are difficult to control because of their tendency to expand. The aim of this research was to evaluate the effectiveness of intralesional injection of bleomycin as a sclerosing agent in conjunction with surgical excision of vascular lesions for the therapy of vascular lesions. Methods: This study was an interventional one arm trial conducted on 18 patients with vascular malformation. The lesion was grossly removed surgically, without sacrificing any important structure, bleomycin was used to be injected intralesional with injection in parts adherent to vital structure. Dilution of bleomycin and amount are tailored to each patient according to size of the lesion and total body weight. Results: the median age of the studied patients was 3.5 years. Nine cases (50%) were females, and nine cases (50%) were males. 14 cases had vascular anomalies in the head and neck (77.8%) while 2 cases had vascular anomalies in the back (11.1%), one case (5.6%) had vascular anomaly in the chest wall and one case was occupying abdomen and lumbar region and extending to the groin (5.6%). most of the cases were cystic hygroma 14 cases (77.8%), two cases were venous malformation (11.1%) and two cases were hemangiomas (11.1%). No cases acquired nerve injury, visceral injury, vascular injury, solid organ injury or mortality as intraoperative complications. intraoperative bleeding in (one case) and respiratory affection in (one case). Postoperatively, the most prevalent complication was edema (nine cases), partial recurrence (six cases), unsightly scar (three cases) and transient nerve affection (two cases). 11 cases (61.1%) had good response at 1st attack, while six cases (33.3%) had satisfactory response and one case (5.6%) had poor response. 15 cases (83.3%) needed single injection with excision of the lesion intraoperative, two cases (11.1%) needed 2 injections. One intraoperative and the second time percutaneously under sedation. One case (5.6%) had venous malformation and needed 7 injections of bleomycin, one injection intraoperative and six injections thereafter. 14 parents (77.8%) were completely satisfied, 3 parents (16.7%) were moderately satisfied, and one parent was unsatisfied (5.6%). Conclusion: Surgical excision combined with intralesional injection of Bleomycin as a sclerosing agent is effective as a primary strategy in management of vascular malformation with better aesthetic outcomes as demonstrated by parents’ and surgeons’ satisfaction associated with low recurrence rates and manageable complications.
 
Keywords
Vascular malformations; Bleomycin; Sclerotherapy; Surgical Excision
References

  1. Greene AK, Kim S et al (2008). Risk of vascular anomalies with Down syndrome. Pediatrics 121: e135–e140.
  2. Haggstrom AN, Drolet BA et al (2007). Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr 150: 291–294.
  3. Tasnádi, G. (2009). Epidemiology of vascular malformations. In Hemangiomas and Vascular Malformations: An Atlas of Diagnosis and Treatment (pp. 109-110). Milano: Springer Milan.
  4. Lei ZM, Huang XX et al (2007). Surgery of lymphatic malformations in oral and cervicofacial regions in children. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104: 338–344.
  5. Bai Y, Jia J et al (2009). Sclerotherapy of microcystic lymphatic malformations in oral and facial regions. J Oral Maxillofac Surg 67: 251–256.
  6. Hassan Y, Osman AK, Altyeb A. Noninvasive Management of Hemangioma and Vascular Malformation Using Intralesional Bleomycin Injection. Ann plast surg.2013 jan; 70(1): 70-73.
  7. Muir T, Kirsten M, Fourie P, et al: Intralesional bleomycin injection (IBI) treatment for haemangiomasand congenital vascular malformations. Pediatr Surg Int 2004, 19:766-773.
  8. Waner M,O TM. The Role of Surgery in the Management of Congenital Vascular Anomalies. Tech vasc interv radiol.2013 Mar;16(1):45-50.
  9. Umezawa H (1966) Purification of bleomycins. J Antibiot 19:21–215
  10. Bhatnagar, A., Upadhyaya, V. D., Kumar, B., Neyaz, Z., & Kushwaha, A. (2017). Aqueous intralesional bleomycin sclerotherapy in lymphatic malformation: Our experience with children and adult. National journal of maxillofacial surgery, 8(2), 130–135. https://doi.org/10.4103/njms.NJMS_6_17
  11. Drug Approval Package: Bleomycin NDA #064084
  12. Jin, L., Chen, J., & Li, X. (2017). Surgical excision with bleomycin irrigation: A better primary treatment choice for pediatric submandibular lymphatic malformations. Journal of Oral and Maxillofacial Surgery, 75(2), 437-e1.
  13. Thorburn, C., & Price, D. (2022). Expectant management of pediatric lymphatic malformations: a 30-year chart review. Journal of Pediatric Surger, 57(5), 883-887.
  14. Prat, D., Gomel, N., Zloto, O., Anne, M., BenSaid, A., Bhattacharjee, K., ... & Ben Simon, G. J. (2020). Low-dose bleomycin injections for orbital lymphatic and lymphatic-venous malformations: a multicentric case series study. Ophthalmic Plastic and Reconstructive Surgery, 37(4), 361-365.
  15. Okazaki, T., Iwatani, S., Yanai, T., Kobayashi, H., Kato, Y., Marusasa, T., ... & Yamataka, A. (2007). Treatment of lymphangioma in children: our experience of 128 cases. Journal of pediatric surgery, 42(2), 386-389.
  16. Kulungowski, A. M., & Patel, M. (2020). Lymphatic malformations. In seminars in pediatric surgery, 29(5), 150971. WB Saunders.
  17. Li, J., Zhong, W., Geng, X., Liu, X., Zhang, X., Wang, Y., & Li, H. (2020). Ultrasonographic diagnosis, classification, and treatment of cervical lymphatic malformation in paediatric patients: a retrospective study. BMC pediatrics, 20, 1-7.
  18. Ardıçlı, B., Karnak, İ., Çiftçi, A. Ö., Tanyel, F. C., & Şenocak, M. E. (2016). Sclerotherapy with bleomycin versus surgical excision for extracervical cystic lymphatic malformations in children. Surgery today, 46, 97-101.
  19. Sheng, L., Yu, Z., Li, S., Cao, W., & Jiang, Z. (2021). Bleomycin sclerotherapy for large diffuse microcystic lymphatic malformations. Gland Surgery, 10(6), 1865.
  20. Lerat, J., Mounayer, C., Scomparin, A., Orsel, S., Bessede, J. P., & Aubry, K. (2016). Head and neck lymphatic malformation and treatment: clinical study of 23 cases. European annals of otorhinolaryngology, head and neck diseases, 133(6), 393-396.
  21. Kalwani, N. M., & Rockson, S. G. (2021). Management of lymphatic vascular malformations: a systematic review of the literature. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 9(4), 1077-1082.
 

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