Surgical management of vascular anomalies in children at a tertiary care hospital in a resource-limited setting: a Tanzanian experience with 134 patients

Abstract

BackgroundVascular anomalies pose major diagnostic and therapeutic challenges among pediatricians and pediatric surgeons practicing in resource limited countries. There is paucity of published data regarding this subject in Tanzania and Bugando Medical Centre in particular. This study describes our experiences on the challenges and outcome of surgical management of childhood vascular anomalies in our environment.MethodsBetween January 2009 and December 2013, a prospective study on the surgical management of vascular anomalies was undertaken at Bugando Medical Centre.ResultsA total of 134 patients (M; F = 1:2.5) were studied. The median age at presentation was 6 years. Of the 134 patients, 101 (75.4 %) were diagnosed as having vascular tumors and 33 (24.6 %) had vascular malformations. The head and the neck were the most frequent anatomical site recorded as having a tumor (56.7 % of patients). Out of 134 patients, 129 (96.3 %) underwent surgical treatment. Failure to respond to non-operative treatment (86.8 %), huge disfiguring/obstructing mass (4.7 %), infection (3.1 %), ulceration (3.1 %) and hemorrhage (2.3 %) were indications for surgical intervention. Tumor excision and primary wound closure was the most common type of surgical procedure performed in 80.6 % of patients. Surgical site infection was the most frequent complications accounting for 33.8 % of cases. Mortality rate was 1.5 %. Tumor excision and primary wound closure gave better outcome compared with other surgical options (p < 0.001). Outcome of injection sclerotherapy in 3 (3.7 %) children, serial ligation of feeder vessels employed in 2 (1.6 %), and conservative treatment in 5 (3.7 %), were poor and required conversion to surgical excision. Despite low mortality rate recorded in this study, but ugly scar, 14 (20.6 %) and limb deformity, 6 (8.8 %) were problems. The overall result of surgical treatment at the end of follow up period was excellent in 108 (87.1 %) patients.ConclusionSurgical excision and primary wound closure gave good outcome which could be employed in complicated and vascular anomalies which failed to respond to other treatment in regions with limited resources.

Infantile Hemangiomas Cleared by Combined Therapy With Pulsed Dye Laser and Propranolol

“…Skin bulging and scarring characterized by remaining fibrofatty tissue is particularly common, occurring in 25% to 68.6% of cases. [52][53][54][55][56][57] In our case series, sequelae after treatment-induced cure were similarly common: 12 of the 27 patients (44.4%) had a sequela, 9 of which involved skin bulging and scarring. Thus, combination therapy did not increase the rate of sequela compared with the literature.…”

Birthmarks and Vascular Anomalies in Children: Classification, Diagnosis and Management

“…In order to effectively treat vascular anomalies, a collaborative approach involving paediatricians, plastic surgeons, interventional radiologists, paediatric surgeons, otorhinolaryngologists, and paediatric oncologists is necessary. In many centres, a variety of treatment modalities, including conservative treatment, surgical excision, injection sclerotherapy, cryotherapy, laser therapy, angiographic embolization, angioplasty/binding of feeder's vessels, the use of angiogenesis inhibitor drugs, and particularly the use of readily available corticosteroids, have produced positive results (19). Sainsbury et al reported that, with acceptable morbidity and recurrence profiles, intralesional bleomycin injection effectively cured complex and recurrent vascular anomalies (20).…”