Potential complications of intralesional laser photocoagulation for extensive vascular malformations

Vascular anomalies remain a challenge for both patients and plastic surgeon s. Recently, promising results have been reported using intralesional photo coagulation (ILP) to treat extensive vascular lesions. At the authors' cent er, they have treated more than 300 patients with vascular anomalies in dif ferent parts of the body between 1996 and 1999. They describe their operati ve techniques of ILP. Laser pulses of a 1,064-nm wavelength from the Nd:YAG laser were delivered to the target tissues with a 600-mum optical fiber. T hey report 2 patients who developed complications after a single session of ILP therapy for their extensive vascular malformations. The first patient had Klippel-Trenaunay syndrome (capillary-lymphaticovenous malformations) w ith widespread involvement of her buttocks and left lower limb. She had sev ere leukocytosis, thrombocytosis, and hyperkalemia that resolved with intra venous hydration, antibiotics, and sodium bicarbonate. In their second pati ent, the entire left upper limb was affected. Her total red cell count dimi nished by a quarter and her hemoglobin concentration dropped by more than 3 g%. This was corrected gradually with supplemental oral hematinics. Althou gh these complications resolved uneventfully in their patients, they hope t hat their possible development will caution anyone who may wish to attempt this new method of therapy.