Sclerotherapy for vascular malformations: complications and a review of techniques to avoid them.

PURPOSE: Interventional radiology has a principal role frequently replacing surgery in the multidisciplinary management of vascular malformations. Having noticed an initial high rate of complications, we examined our early experience to study in detail the outcomes and risks. We also present a review of techniques to reduce these complications. MATERIALS AND METHODS: Data were collected during a 5-year period on patients who had completed treatment. The two sclerosants used were either 100% alcohol or 3% sodium tetradecyl sulphate (STS) as sole agents, or in combination. We graded early clinical and radiological outcomes. Binary logistic regression analysis was carried out for variables (age, type of vascular malformation and number of sclerotherapy sessions) that may predict the occurrence of complications. RESULTS: Twenty-four patients (11 males and 13 females) completed treatment during this period and were the subject of this review. There were a total of 46 sessions with an average of two (range: one to five). The mean and median ages were 36.2 and 38 years, respectively. Nineteen patients had venous malformations and five had lymphatic malformations. Most of the vascular malformations were in the head and neck region (66.7%). Although the overall early results were favourable (21 out of 24 patients had partial or complete resolution clinically and radiologically), there were four nerve-related and three skin-related complications. Using alcohol alone (13 patients, 24 sessions) there were one skin and three nerve injuries; with STS alone (five patients, 19 sessions) there was one skin complication; and when in combination (six patients, three sessions) one nerve and one skin complications. CONCLUSION: More complications were seen with the use of alcohol, including all the nerve-related injuries, prompting a change of practice to favour STS as the primary agent, especially for head and neck lesions.

Predictors of mortality in paediatric burns at Ibadan, Nigeria

Burn injury constitutes a major cause of trauma related morbidity and mortality. Improvements in care have resulted in reduced mortality in the burn patient significantly. The aim of this study was to determine the outcome and management of burns in children. This was a prospective study of children aged 0-13 years, managed in the burns unit of University College Hospital, Ibadan, Nigeria, between January 2001 and September 2003. There were 62 patients, 42 (67.7%) were females and 20 (32.3%) were males (Male: Female= 1:2. Their ages ranged between 1month and 13 years (mean = 4.8 ± 3.8 years). Majority of the patients (56.5%) were below 4 years of age. Burn was caused predominantly by flame (57%), followed by inhalation injury in 43.5% of the patients. The percentage total burn surface area (%TBSA) ranged between 1%and 95%(mean 29.7%± 22.8%), and 41.4% of the patients sustained amajor burn (TBSA= 30%). Infective complications were present in 37% of patients. The overall mortality was 33.9%, and occurred in those patients with %TBSA of 14 95% (mean = 48.8%). Mortality rate was 62.9% among those that had inhalation injury compared with 11.4% in those without inhalation injury. There was no mortality in those patients whose %TBSAranged between 1 and 32%(mean = 17.5%). Percentage of the total body surface area burnt and the presence of inhalation injury were important predictors ofmortality in childhood burns injury