Intramuscular haemangiomas: Hookwire localization prior to surgical excision: Report of four cases

Background: Haemangiomas of skeletal muscle are a rare entity, although the y are still noted to be one of the most common deep tissue tumours of the l ower limb. All such lesions are benign with no recorded evidence of metasta sis; but they are associated with a 17-20% local recurrence rate which is t hought to be related to inadequate primary surgical excision rather than hi stological subtype. Methods: The present case series briefly discusses the pathophysiology, cli nical manifestations, diagnostics, differential diagnosis and treatment mod alities of intramuscular haemangiomas. The article then focuses on the rece nt introduction of ultrasound-guided hookwire localization, which has enabl ed a great increase in complete surgical excision, resulting in much lower rates of local recurrence and a more pleasing functional and cosmetic resul t because unnecessary dissection is avoided. Results: Preoperative ultrasound-guided hookwire localization of deep and o ften non-palpable intramuscular haemangiomas was very helpful in enabling a more complete surgical excision to be carried out. Conclusion: Hookwire localization using ultrasound guidance is an invaluabl e tool in directing the surgeon intraoperatively when excising deep intramu scular haemangiomas.