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Mahmoud, N. (2020). Effect of Foam and Liquid Bleomycin in the Management of Venous Malformations in Head and Neck Region. A Comparative Study. The Egyptian Journal of Plastic and Reconstructive Surgery, 43(3), 401-408. doi: 10.21608/ejprs.2020.68170
Nada A Mahmoud. "Effect of Foam and Liquid Bleomycin in the Management of Venous Malformations in Head and Neck Region. A Comparative Study". The Egyptian Journal of Plastic and Reconstructive Surgery, 43, 3, 2020, 401-408. doi: 10.21608/ejprs.2020.68170
Mahmoud, N. (2020). 'Effect of Foam and Liquid Bleomycin in the Management of Venous Malformations in Head and Neck Region. A Comparative Study', The Egyptian Journal of Plastic and Reconstructive Surgery, 43(3), pp. 401-408. doi: 10.21608/ejprs.2020.68170
Mahmoud, N. Effect of Foam and Liquid Bleomycin in the Management of Venous Malformations in Head and Neck Region. A Comparative Study. The Egyptian Journal of Plastic and Reconstructive Surgery, 2020; 43(3): 401-408. doi: 10.21608/ejprs.2020.68170

Effect of Foam and Liquid Bleomycin in the Management of Venous Malformations in Head and Neck Region. A Comparative Study

Article 9, Volume 43, Issue 3, October 2020, Page 401-408  XML PDF (5.89 MB)
Document Type: Original Article
DOI: 10.21608/ejprs.2020.68170
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Author
Nada A Mahmoud*
The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Abstract
Background: Many treatment options for Venous Malformations
(VM) has been documented in the literature but injection
sclerotherapy has been considered a current mainstay for their
treatment. We conducted this study to determine efficacy and
durability of different injectable forms of bleomycin sclerotherapy
in the treatment of VMs in cervico-facial region.
Patients and Methods: Thirty patients complaining of
venous malformation in the head and neck region, diagnosed
clinically and confirmed by magnetic resonance imaging, had
been injected with bleomycin sclerosing material. They were
divided into two equal groups according to the form of
bleomycin injected; Group A: Foam form was injected and
Group B: Liquid form was injected. Patient's data, anatomical
sites, type and volume of the VM, number of injection sessions
and the average dose of injected agents were documented and
statistically compared between the 2 groups.
Results: MRI imaging showed a decline of more than
90% from the initial size of lesions in 66.7% cases and
considerable decline (60%-90%) in 33.3% of cases. In Group
A the number of sessions were (1-4), while in Group B were
(1-6). the amount of sclerosing material injected in Group A
were (2-7.5mg), while in Group B were (3.5-13mg), which
was statistically significant. The cumulative dose in the equal
size lesions was lower in the foam form rather than the liquid
one, and show statistically significant difference.
Conclusion: Foam form has greater promise compared
with liquid form in the treatment of VMs and would encourage
us to continue use the bleomycin in its foam form in the future
on a bigger number of patients with larger size lesion and
different location without reaching to the toxic cumulative
life time dose.
Keywords
Venous malformations – Head and neck – Foam –; Liquid – Bleomycin
Main Subjects
Congenital anomalies; New technologies and products
Supplementary Files
References
1- Derby L.D. AND Low D.W.: Laser treatment of facial
venous vascular malformations. Ann. Plast. Surg., 38:
371-8, 1997.
2- Mahady K., Thust S., Berkeley R., Stuart S., Barnacle A.,
Robertson F. and Mankad K.: Vascular anomalies of the
head and neck in children. Quant. Imaging Med. Surg.,
Dec., 5 (6): 886-97, 2015.
3- Mulliken J.B. and Glowacki J.: Hemangiomas and vascular
malformations in infants and children: A classification
based on endothelial characteristics. Plast. Reconstr. Surg.,
69: 412Y420, 1982.
4- ISSVA classification for vascular anomalies© (approved
at the International Society for the Study of Vascular
Anomalies workshop, Melbourne, April 2014). Available
from URL: issva.org/classification (accessed October
2016).
5- Lee B.B.: Critical issues on the management of congenital
vascular malformation. Ann. Vasc. Surg., 18: 380-92,
2004.
6- Belov S.: Anatomopathological classification of congenital
vascular defects. Semin. Vasc. Surg., 6 (4): 219-24, 1993.
7- Belov S.T.: Classification of congenital vascular defects.
Int. Angiol., 9: 141-6, 1990.
8- Deveikis J.P.: Percutaneous ethanol sclerotherapy for
vascular malformations in the head and neck. Arch. Facial
Plast. Surg., 7: 322-5, 2005.
9- Greene A.K. and Alomari A.I.: Management of venous
malformations. Clin. Plast. Surg., 38: 83-93, 2011.
10- Sachin K., Rashmi S., Manish S., et al.: Haemangiomas
and venous malformations of the head and neck: A retrospective
analysis of endovascular management in 358
patients. Indian J. Plast. Surg., 109-16, 2013.
11- Legiehn G.M. and Heran M.K.: Classification, diagnosis,
and interventional radiologic management of vascular
malformations. Orthop. Clin. North Am., 37: 435-74,
2006.
12- Legiehn G.M. and Heran M.K.: Venous malformations:
Classification, development, diagnosis, and interventional
radiologic management. Radiol. Clin. North Am., 46:
545-97, 2008.
13- Zheng J.W., Yang X.J., Wang Y.A., et al.: Intralesional
injection of Pingyangmycin for vascular malformations
in oral and maxillofacial regions: An evaluation of 297
consecutive patients. Oral Oncol., 45: 872-6, 2009.
14- Yang Y., Sun M., Ma Q., et al.: Bleomycin A5 sclerotherapy
for cervico-facial lymphatic malformations. J. Vasc.
Surgery, 53: 150-5, 2011.
15- Yang Y., Sun M., Cheng X., et al.: Bleomycin A5 plus
dexamethasone for control of growth in infantile parotid
hemangiomas. Oral Surg. Oral Med. Oral Pathol. Oral
Radiol Endod., 108: 62-9, 2009.
16- Muir T., Kirsten M., Fourie P., et al.: Intralesional Bleomycin
Injection (IBI) treatment for haemangiomas and
congenital vascularmal formations. Pediatr. Surg. Int.,
19: 766-73, 2004.
17- Zhao J.H., Zhang W.F. and Zhao Y.F.: Sclerotherapy of
oral and facial venous Malformations with use of pingyangmycin
and/or sodium morrhuate. Int. J. Oral Maxillo.
Fac. Surg., 33: 463-6, 2004.
18- Zhi K., Wen Y., Li L., et al.: The role of intralesional
Pingyangmycinin the treatment of venous malformation
official and maxillary region. Int. J. Pediatr. Otorhinolaryngol.,
72: 593-7, 2008.
19- Seigel R.D. and Schiffman F.J.: Systemic toxicity following
intracavitatory administration of bleomycin, Chest, 98
(2): 507, 1990.
20- Luce J.K.: Clinical trial of bleomycin in solid tumours
and lymphomas. Proc. Am. Assoc. Cancer Res., 10: 38,
1969.
21- Tessari L., Cavezzi A. and Frullini A.: Preliminary experience
with a new sclerosing foam in the treatment of
varicose veins. Dermatol. Surg., 27: 58-60, 2001.
22- Yamaki T., Nozaki M., Fujiwara O., et al.: Duplex-guided
foam sclerotherapy for the treatment of the symptomatic
venous malformations of the face. Dermatol. Surg., 28:
619-22, 2002.
23- Cabrera J., Cabrera J. Jr., Garcia-Olmedo A. and Redondo
P.: Treatment of venous malformations with sclerosant in
microform foam. Arch. Dermatol., 139: 1409-16, 2003.
24- Pascarella L., Bergan J.J., Yamada C. and Mekenas L.:
Venous angiomata: Treatment with sclerosant foam. Ann.
Vasc. Surg., 19: 457-64, 2005.
25- Bergan J., Pascarella L. and Mekenas L.: Venous disorders:
Treatment with sclerosant foam. J. Cardiovasc. Surg., 47:
115-24, 2005.
26- Yamaki T., Nozaki M., Sakurai H., et al.: Prospective
randomized efficacy of ultrasoundguided foam sclerotherapy
compared with ultrasound-guided liquid sclerotherapy
in the treatment of symptomatic venous malformations,
Journal of Vascular Surgery, March, 578-84, 2008.
27- Ul Haq F., Mitchell S.E., Tekes A. and Weiss C.R.:
Bleomycin foam treatment of venous malformations: A
promising agent for effective treatment with minimal
swelling. J. Vasc. Interv. Radiol., 26: 1484-93, 2015.
28- Azene E., Mitchell S., Radvany M., et al.: Foamed Bleomycin
Sclerosis of Airway Venous Malformations: The
Role of Interspecialty Collaboration Laryngoscope, 126:
2726-32, 2016.
29- Berenstein A.: E-059 Bleomycin Sclerotherapy for Eyelid
Venous Malformations as an Alternative to Surgery or
Laser Therapy Journal of Neuro Interventional Surgery,
8: A74, 2016.
30- Xiaofan Pan and Dylan Wolman: Percutaneous bleomycin
foam effectively treats venous malformations. July 13,
2015.
31- Cooper A. and Kennedy M.W.: Biofoams and natural
protein surfactants. Biophys. Chem., 151: 96-104, 2010.
32- Zhang W., Chen G., Ren J.G., et al.: Bleomycin induces
endothelial mesenchymal transition through activation of
mTOR pathway: A possible mechanism contributing to
the sclerotherapy of venous malformations. Br. J. Pharmacol.,
170: 1210-20, 2013.
33- Huang Y., Li P., Xia S., et al.: Proapoptotic effect and the
mechanism of action of pingyangmycin on cavernous
hemangiomas. Exp. Ther. Med., 7: 473-7, 2014.
34- Mabeta P. and Davis P.F.: The mechanism of bleomycin
in inducing haemangioma regression. S Afr. Med. J., 98:
538-9, 2008.
408 Vol. 43, No. 3 / Effect of Foam & Liquid Bleomycin in the Management of Venous Malformations
35- Li P., Li D., Guo Z., et al.: Therapeutic mechanism of
bleomycin A5 on infancy hemangioma: an experimental
study. Zhonghua Kou Qiang Yi Xue Za Zhi, 48: 18-22,
2003.
36- Li P., Xiao X. and Guo Z.: Effect of bleomycin A5 on the
hemangioma-derived endothelial cell line XTPS-1. Zhonghua
Kou Qiang Yi Xue Za Zhi, 47: 324-8, 2012.
37- Yura J., Hashimoto T., Tsuruga N., et al.: Bleomycin
treatment for cystic hygroma in children. Nihon Geka
Hokan, 46: 607-14, 1977.
38- Tanigawa N., Shimomatsuya T., Takahashi L., et al.:
Treatment of cystic hygroma and lymphangioma with
the use of bleomycin fat emulsion. Cancer, 60: 741-9,
1987.
39- Muir T., Kirsten M., Fourie P., et al.: Intralesional Bleomycin
Injection (IBI) treatment for haemangiomas and
congenital vascular malformations. Pediatr. Surg. Int.,
19: 766-73, 2004.
40- Mathur N.N., Rana I., Bothra R., et al.: Bleomycin sclerotherapy
in congenital lymphatic and vascular malformations
of head and neck. Int. J. Pediatr. Otorhinolaryngol.,
69: 75-80, 2005.
41- Sainsbury D.C., Kessell G., Fall A.J., et al.: Intralesional
bleomycin injection treatment for vascular birthmarks: A
5-year experience at a single United Kingdom Unit. Plast.
Reconstr. Surg., 127: 2031-44, 2011.
42- Baskin D., Tander B. and Bankaoglu M.: Local bleomycin
injection in the treatment of lymphangioma. European
Journal of Pediatric Surgery: Official journal of Austrian
Association of Pediatric Surgery. [et al.]=Zeitschrift fur
Kinderchirurgie, 15: 383-6, 2005.
43- Mowad C.M., Nguyen T.V., Elenitsas R., et al.: Bleomycininduced
flagellate dermatitis: A clinical and histopathological
review. Br. J. Dermatol., 131: 700-02, 1994.
44- Sung M.W., Chang S.O., Choi J.H., et al.: Bleomycin
sclerotherapy in patients with congenital and lymphatic
malformation in the head and neck. Am. J. Otolaryngol.,
16: 236-41, 1995.
45- Gregorya S., Burrows P.E., Ellinas H., et al.: Combined
Nd: YAG laser and bleomycin sclerotherapy under the
same anesthesia for cervicofacial venous malformations:
A safe and effective treatment option. International Journal
of Pediatric Otorhinolaryngology, 108: 30-4, 2018.
46- Lee H.J., Kim T.W., Kim J.M., et al.: Percutaneous
sclerotherapy using bleomycin for the treatment of vascular
malformations. International Journal of Dermatology, 56:
1186-91, 2017.
47- Hou R., Guo J., Hu K., Yang Y., et al.: A clinical study
of ultrasound-guided intralesional injection of bleomycin
A5 on venous malformation in cervical-facial region in
China. J. Vasc. Surg., Vol. 51, 940-5, 2010

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