Wenxin Yu

Prospective comparison treatment of 595-nm pulsed-dye lasers for virgin port-wine stain

Vbeam® and Cynergy® are 595‐nm pulsed‐dye laser (PDL) equipment options, both extensively used in the clinical treatment of port‐wine stains (PWS). However, there has been no study conducted of the differences in PWS therapeutic outcomes across both devices.

Is Propranolol Safe and Effective for Outpatient Use for Infantile Hemangioma? A Prospective Study of 679 Cases From One Center in China.

Background The protocol for the treatment of infantile hemangioma with propranolol varies among different clinical centers. Methods Six hundred seventy-nine patients who were 1 to 12 months old were recruited in this prospective study to receive propranolol treatment. The response to the propranolol therapy was classified as 4 levels. The results were primarily evaluated using color Doppler ultrasound examinations before and after propranolol treatment. Results The response was excellent in 176 (25.9%), good in 492 (72.5%), stable in 5 (0.7%), and poor in 6 (0.9%) of the patients. The mean age at the initiation of the therapy was 3.3 months (range, 1 to 10.9 months) and the mean duration of the therapy was 7.1 months (range, 3–17 months). The mean duration of the follow-up time after the discontinuation of the therapy was 5.3 months (range, 3–17 months). Regrowth of the hemangioma was observed in 92 cases (13.5%). Seventy-nine (11.6%) of the parents complained of their child’s minor discomfort during the therapy. Conclusions Propranolol (2 mg/kg per day) may significantly reduce the size of a hemangioma. As an outpatient therapy, propranolol was found to be safe for Chinese children and to have minor side effects.

Recurrence of infantile hemangioma after termination of propranolol treatment.

Propranolol has been the first-line treatment for problematic infantile hemangioma (IH) since 2008. The recurrence of IHs after stopping treatment with propranolol was reported in several studies. Mechanisms underlying this phenomenon have not been elucidated so far. Our study is the first to show the general pathology of recurrence of IH after stopping treatment with propranolol. It can provide help for the clinical treatment of IHs.

Occurrence of Bruise, Hematoma, and Pain in Upper Blepharoplasty Using Blunt-Needle vs Sharp-Needle Anesthetic Injection in Upper Blepharoplasty: A Randomized Clinical Trial.

Importance Though it has been a common practice to use sharp needles to administer local anesthesia for upper blepharoplasty, the evidence for their benefit is lacking. Objective To evaluate whether there is any benefit of using blunt-needle injection for local anesthesia when performing upper blepharoplasty to reduce postoperative bruise, hematoma, and pain. Design, Setting, and Participants Randomized clinical trial of 44 patients who underwent bilateral upper blepharoplasty in an academic medical setting were randomized to receive local anesthesia injections (lidocaine, 2%; 27-gauge needle) with a blunt needle in one eyelid and a sharp needle in the other eyelid. Main Outcomes and Measures Visual analog scale (VAS) score of 0 to 10 (lower score indicating lower level of pain) was used to blindly assess pain in patients receiving anesthesia injections with both needle types. After injection and skin incision, photographs of the eyelids of each patient were taken and used by 2 blinded observers to identify bruise or hematoma. Results In the 44 patients (88 eyelids) included in the study (all women; mean age, 31 years; age range, 18-56 years) bruise or hematoma occurred at the sharp-needle injection site in 11 women (25%) vs 0 women at the blunt-needle site (P < .001). The mean VAS scores were 5.48 and 4.64 for pain assessed at sites of sharp- and blunt-needle injections, respectively (P = .002). Conclusions and Relevance Use of blunt needles to administer local anesthesia when performing upper blepharoplasty is less likely to cause hemorrhage and require interventional pain procedures than use of sharp needles. Therefore, for a more accurate surgical procedure and faster recovery, a blunt needle may be a preferable choice. The use of the blunt needle presents fewer complications and allows more accurate and refined work with faster patient recovery. Level of Evidence 1. Trial Registration Chinese Clinical Trial Registry identifier: ChiCTR-ONC-16007979

Prospective, open-label, rater-blinded and self-controlled pilot study of the treatment of proliferating superficial infantile hemangiomas with 0.5% topical timolol cream versus 595-nm pulsed dye laser

Topical timolol and 595‐nm pulsed dye laser (PDL) are both widely used in the treatment of superficial infantile hemangiomas (IH). However, to date, there is no reliable study comparing the therapeutic outcomes between the two treatment options. We designed the present study to evaluate and compare the efficacy and safety of timolol cream and PDL in the treatment of superficial proliferating IH. Twenty‐one patients with superficial IH were included in the study. Each lesion was divided into two regions; one part was treated with 0.5% topical timolol cream four times daily, and the other part was treated monthly with PDL. Both treatments were continued for 2–6 months. Five independent and blinded assessors were asked to judge the results in both the topical timolol‐treated and PDL‐treated parts by comparing photographs taken before and after treatment. Both treatments resulted in significant clinical improvements after 3.39 sessions in the 2‐month follow up. The average visual evaluation showed that PDL had significantly better results than topical timolol (6.55 ± 2.26 to 4.98 ± 2.92, P < 0.01). No patients experienced permanent side‐effects during the treatment. Our short‐term study revealed that PDL had better results compared with topical timolol cream application in the treatment of superficial proliferating IH. Further studies with longer follow‐up time and larger sample size are required to validate our findings.

The Modified Z-Epicanthoplasty-A Stepwise and Individualized Design.

Purpose To describe a medial epicanthoplasty technique using a stepwise, customized design and to review the outcome in Asian patients after the treatment of medial epicanthal fold. Design Retrospective, noncomparative and interventional case series with the introduction of a new surgical technique. Participants Forty-eight consecutive Asian patients with primary medial epicanthal fold. Methods Patient charts were reviewed from patients (mean age, 24.6 ± 3.8 years; range, 19–40 years) with a stepwise z-epicanthoplasty. The intercanthal distance (ICD), interpupillary distance (IPD), and scar visibility were evaluated at regular intervals (preoperative, immediate postoperative, 3 months, 6 months, and 1 year after the operation). The ratio of the ICD to IPD (ICD ratio) was calculated, and the visibility of the surgical scar assessed. Main Outcome Measures Postoperative improvement in ICD ratio and scar quality. Results The preoperative median ICD ratio was 0.60 (range, 0.57–0.66) and decreased to 0.57 (range, 0.52–0.60) postoperatively. The median ICD ratio reduction was 5.6% (range, 2.6–14.1%; P < 0.001, Wilcoxon signed-rank test). Forty patients (83.3%) had no visible scarring or scarring only visible under close inspection. Eight patients (16.7%) experienced a more apparent scar, but none of them developed a severe scar requiring revision. Conclusions The modified z-epicanthoplasty using a stepwise design is a customized and effective technique for the treatment of the epicanthal fold. This method has a short learning curve, is widely applicable to various types of epicanthal fold, and has a high satisfaction rate with a stable long-term result.

Management of periorbital microcystic lymphatic malformation with blepharoptosis: Surgical treatment combined with intralesional bleomycin injection

OBJECTIVES Periorbital microcystic lymphatic malformations (LM) can cause severe symptoms, such as blepharoptosis, amblyopia, chemosis, strabismus, diminished vision, and blindness. The purpose of this study was to evaluate the clinical outcome in periorbital microcystic LM patients with blepharoptosis who underwent surgical treatment combined with intralesional bleomycin injection. PATIENTS AND METHODS A retrospective study including nine patients diagnosed as periorbital microcystic LM with blepharoptosis was conducted. All of the patients underwent surgical treatment and bleomycin injection from January 2010 to January 2014. The lesion was resected through the lower eyebrow and/or a coronal incision at the first stage, and levator resection was performed at the second stage. Any persistent lesion or its recurrence was managed by intralesional bleomycin injection. RESULTS Blepharoptosis and visual obstruction were corrected in all patients. Mean follow-up was 24.6 months. Six patients had recurrence during the follow-up, and two patients who had partial eyelid closure after the second stage surgery recovered in three months. Amblyopia, astigmatism, and strabismus were not improved after treatment. All of the patients had excellent aesthetic improvement and corrected blepharoptosis. CONCLUSIONS Resection through a lower eyebrow and coronal incision and levator resection performed in two stages can quickly correct the visual impairment caused by periorbital microcystic lymphatic malformation with blepharoptosis. Intralesional bleomycin injection is a promising adjunctive therapy for residual or recurrent lesions after surgery.

A Split-Face, Single-Blinded, Randomized Controlled Comparison of Alexandrite 755 nm Picosecond Laser vs. Alexandrite 755 nm Nanosecond Laser in the Treatment of Acquired Bilateral Nevus of Ota-like Macules (ABNOM)

Background: Q‐switched alexandrite lasers (QSALs) have been used for the treatment of acquired bilateral nevus of Ota–like macules (ABNOMs). Currently, picosecond alexandrite laser (PSAL) pulses have become available for pigmentary disorders. However, no studies have compared PSAL and QSAL in the treatment of ABNOM. Objective: We sought to compare the efficacy and safety of PSAL and QSAL in the treatment of ABNOM. Methods: Each patient (n = 30) received 3 treatments at 6‐month intervals. Matching areas were delimitated on the face of each patient (left/right comparison); 1 side was treated with PSAL and the other side was treated with QSAL. The safety and efficacy of the 2 lasers were determined by visual assessment and self‐report from patients 6 months after the final treatment. Results: The PSAL‐treated area achieved significantly better clearance (3.73 vs 2.4) with less severe pain (4.47 vs 5.16). The incidence rate of postinflammatory hyperpigmentation was 27.77% and 54.44% for the PSAL and QSAL treatments, respectively, and the duration of postinflammatory hyperpigmentation was 1.32 and 1.74 months, respectively (P < .001). Limitations: The limitations of our study include the small sample size and the lack of objective evaluation. Conclusion: Compared with QSAL, PSAL therapy afforded significantly better clinical outcomes and fewer side effects in the treatment of ABNOM.

Ethanol Embolotherapy for the Management of Refractory Chronic Skin Ulcers Caused by Arteriovenous Malformations

PURPOSE To describe the clinical features and treatment outcomes of ethanol embolotherapy in refractory chronic skin ulcers caused by arteriovenous malformations (AVMs). MATERIALS AND METHODS From October 2011 to October 2015, 12 patients (5 male; mean age, 26.2 y) with refractory chronic skin ulcers caused by AVMs were treated at a single institution. Ethanol embolotherapy was performed by direct puncture techniques. Needles were directly inserted toward the nidus of the lesion based on imaging analysis. When fast blood reflux was noted, angiography was performed to ensure only the nidus and draining vein were opacified. Symptoms before and after treatment, previous treatment of AVMs and ulcers, embolotherapy sessions, follow-up time, complications, and degree of devascularization were recorded. Treatment outcomes were established by evaluating symptom outcomes and the degree of devascularization on follow-up angiography. RESULTS Fifty embolotherapy procedures were performed in 12 patients: 6 underwent procedures on the head and neck, 4 on the feet, and 2 on the hands. Four patients (33.3%) experienced complete resolution of abnormal angioarchitecture according to follow-up angiography. Complete control of ulcers was achieved in all 12 patients. Two procedures (4%) in 2 patients (16.7%) caused superficial skin necrosis that healed spontaneously within 4 weeks. Thirteen procedures (26%) in 9 patients (75%) caused blistering immediately after treatment. There were no major complications. CONCLUSIONS In a limited series, ethanol embolotherapy was effective and safe in the treatment of refractory chronic skin ulcers caused by AVMs.

Safety and Efficacy of Dual Wavelength Laser (1064 nm + 595 nm) for Treatment of Non-treated Port-Wine Stains

Patients with port‐wine stain (PWS) suffer physically and psychologically because of the high incidence (0.3%–0.5%) of the disease. Pulsed‐dye laser (PDL) at 595 nm is the gold standard of the treatment for PWS. Nevertheless, clinicians intend to determine whether the dual‐wavelength laser (DWL; 595‐nm PDL + 1064‐nm Nd:YAG) is an adequate choice in the treatment of non‐treated PWS. This study is the first prospective within‐patient controlled research seeking to investigate the safety and efficacy of DWL for the treatment of non‐treated PWS.