Adv Pediatr Surg.  2019 Dec;25(2):44-50. 10.13029/aps.2019.25.2.44.

Early Experience of Doxycycline Sclerotherapy for Lymphatic Malformations

• Lee JY
• Namgoong J
• Kim SC
• Kim DY

• KMID: 2466399
• DOI: http://doi.org/10.13029/aps.2019.25.2.44

Abstract

PURPOSE
Lymphatic malformations (LMs) are congenital malformations of the lymphatic system which can be effectively treated by sclerotherapy. This study aims to evaluate the efficacy of doxycycline in the treatment of LMs.
METHODS
We retrospectively reviewed the medical records of all patients who were diagnosed as LMs and underwent doxycycline sclerotherapy in Asan Medical Center between March 2013 and February 2014. Thirty-five sclerotherapy procedures were performed on 21 patients. The procedures were performed under general anesthesia. After each treatment, the clinical and radiographic response was characterized as complete (≥80% decrease in lesion size), partial (<80% decrease of size), or no response (no decrease of size).
RESULTS
There were 11 male patients and 10 female patients. The median age of sclerotherapy was 21 months (range, 2-180 months). The most common location was cervicofacial (52.3%), followed by extremity (28.6%) and truncal (19.0%). The most common lesion type was macrocystic (71.4%), followed by microcystic (28.5%). There was one (2.8%) skin necrosis which was recovered by wound management. Thirty-eight percent of patients had a complete response, 47.6% of patients had a partial response and 14.3% of patients had no response. Median frequency of treatment was one (range, 1-5). No response group consisted of all microcystic type.
CONCLUSION
Sclerotherapy with Doxycycline is safe and effective for macrocystic LMs.

Keyword

Lymphatic abnormalities; Doxycycline; Sclerotherapy

MeSH Terms

Anesthesia, General
Chungcheongnam-do
Doxycycline*
Extremities
Female
Humans
Lymphatic Abnormalities
Lymphatic System
Male
Medical Records
Necrosis
Retrospective Studies
Sclerotherapy*
Skin
Wounds and Injuries
Doxycycline

Figure

• 

  Fig. 1 Sclerotherapy of a neck macrocytic LM under intraoperative ultrasound. (A) Sonographic image of a LM in the operation room. (B) The macrocysts were cannulated using sonographic guidance with a 21-gauge needle and attempt made to aspirate the cyst of its entire content. This was frequently facilitated by the simultaneous manual manipulation of the cyst and syringe by the surgeon. LM, lymphatic malformation.

• 

  Fig. 2 (A) Multilocular septated cystic masses at the soft tissue of both shoulder to mid back area, left neck to left upper thorax wall, left entire arm and hand which was a continuous lesion without skip area and there was no intrathoracic or mediastinal extension. (B) The mass of the neck and chest might cause airway obstruction so excision was performed first when she was 1 year 3 months old.

• 

  Fig. 3 Skin lesion after doxycycline injection which developed skin necrosis.

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