Surgical Excision as the First Therapeutic Choice in Single-muscle Hemangiomas: a Case Series

Abstract

Background: Conservative management is generally the primary treatment for intramuscular hemangimas. However,<br />many patients will require surgery later in their life, after suffering a long period of pain. We aimed to evaluate the<br />oncologic and functional outcomes of surgery as the initial treatment of single-muscle hemangiomas.<br />Methods: Medical profiles of 17 patients with hemangiomas of vastus medialis for whom surgery was selected as<br />the initial treatment were reviewed. The indication for surgery was a bothersome pain. Postoperative muscle strength<br />was assessed with manual muscle testing (range 0-5). The postoperative pain was measured by a visual analog scale<br />(VAS) for pain (range 0-10). Lyshölm-Tegner knee scoring scale was used for the evaluation of knee function.<br />Results: The mean age of the patients was 25.9±8.6 years. Surgery was performed as wide resection in 13 cases and<br />as marginal resection in 4 cases. At a mean follow-up of 55.76±30 months, two local recurrences (11.8%) were observed.<br />At the last evaluation session, muscle strength grade was 5/5 in 13 patients and 4/5 in four patients. Postoperative<br />pain was noticed in four patients (VAS=1). Knee function was excellent in 13 patients and good in four patients. Both<br />of the local recurrences occurred in marginally resected lesions. Three out of four cases with reduced muscle strength,<br />postoperative pain, and reduced function were also treated with marginal resection.<br />Conclusion: If a wide surgical margin is achievable without compromising the limb function, surgical resection could<br />be considered as the primary choice of treatment for single-muscle hemangiomas.<br />Level of evidence: IV