PATRICIA YUKO HIRAKI
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- Reply: Surgical Treatment of Facial Infantile Hemangiomas: An Analysis Based on Tumor Characteristics and Outcomes(2016) GOLDENBERG, Dov C.; HIRAKI, Patricia Y.; MOURA, Tatiana de; KOGA, Andrea; GEMPERLI, Rolf
- Surgical Treatment of Extracranial Arteriovenous Malformations after Multiple Embolizations: Outcomes in a Series of 31 Patients(2015) GOLDENBERG, Dov C.; HIRAKI, Patricia Y.; CALDAS, Jose Guilherme; PUGLIA, Paulo; MARQUES, Tatiana M.; GEMPERLI, RolfBackground: Surgical resection after embolization is the most accepted approach to treating arteriovenous malformations. The authors analyzed the outcome of surgically treated patients and how surgical resection was influenced by multiple embolizations. Methods: Thirty-one patients were included from January of 2000 to December of 2012. The mean patient age was 24.9 years. Anatomical involvement, definition of limits, functional impairment, number of embolizations, type of resection, reconstruction method, blood transfusion, and hospital stay were evaluated. Morbidity, mortality, and regrowth rates and need for additional procedures were evaluated. Results: Lesions were preferentially located at the orbits, cheeks, and lips. The number of embolizations per patient increased with lesion complexity. In 22 cases, total excision was accomplished, and in nine, subtotal resections were performed to favor function. After multiple embolizations, better lesion identification was observed. Primary closure was performed in 20 cases, local flaps were performed in seven cases, axial flaps were performed in two patients, and free flaps were performed in two cases. There were no deaths. Regrowth rates were influenced by limits between arteriovenous malformations and surrounding tissues (15.8 percent of cases with precise limits versus 58.3 percent of lesions with imprecise limits; p = 0.021) and by type of resection (18.2 percent of cases after total resection versus 66.7 percent after subtotal resections; p = 0.015). Conclusions: Multiple therapeutic embolizations seem to increase safety in the treatment of arteriovenous vascular malformations and suggest an additional positive effect besides bleeding control. Preoperative definition of limits and establishment of conditions for total resection are critical to determine management and risk of regrowth.
- Surgical Treatment of Facial Infantile Hemangiomas: An Analysis Based on Tumor Characteristics and Outcomes(2016) GOLDENBERG, Dov C.; HIRAKI, Patricia Y.; MARQUES, Tatiana Moura; KOGA, Andrea; GEMPERLI, RolfBackground: Surgical treatment of infantile hemangiomas may interfere with patient appearance. The use of an algorithm is essential to select candidates. The objective of this study was to evaluate outcomes of surgical treatment based on tumor characteristics. Methods: Seventy-four patients were treated surgically between 1997 and 2010. Demographics, tumor characteristics, surgical approach, and outcomes were evaluated. Results: The female-to-male ratio was 5.7:1. Mean age and follow-up were 24 years and 33 months, respectively. Surgery was elective in 83.8 percent and emergent in 16.2 percent of patients. Most frequent locations were lips, nose, eyelids, and cheeks. Surgery was performed during the proliferative phase in 43 patients (58.1 percent), and growth-related deformity was the main indication. No significant association between sex and the presence of complications or treatment indication was observed. Patients who underwent emergency procedures were younger (p = 0.0031) and had a higher incidence of evolutional complications (p = 0.012). Also, they were more frequently operated on during the proliferative phase (p = 0.011). Favorable outcome of surgical treatment was observed in both simple and complex cases for facial contour, volume reduction, and need for reoperation. The best candidates for elective surgery were patients with localized eyelid, nasal, or lip hemangiomas, presenting growth-related deformities during the proliferative phase. For patients undergoing emergency procedures, the best candidates were nonresponders to pharmacologic therapy with segmental periorbital hemangiomas, treated by partial resection. Conclusions: A profile of patients and their specific surgical approach was established. Satisfactory results could be achieved following the proposed algorithm. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
- Reply: Surgical Treatment of Facial Infantile Hemangiomas: An Analysis Based on Tumor Characteristics and Outcomes(2016) GOLDENBERG, Dov C.; HIRAKI, Patricia Y.; MOURA, Tatiana de; KOGA, Andrea; GEMPERLI, Rolf