Assessment of pulsed-dye laser therapy for pediatric cutaneous vascular anomalies.

Abstract

IMPORTANCE:

Although facial vascular malformations are often treated by facial plastic surgeons, no reliable validated assessment tool exists for surgeons to assess results.

OBJECTIVES:

To use our assessment tool to analyze results from pulsed-dye laser therapy used for pediatric facial vascular malformations, and to determine interrater reliability of our assessment tool in a standard clinical environment without the use of professional photography.

DESIGN:

A blinded retrospective review of pediatric patients who underwent pulsed-dye laser therapy for treatment of hemangiomas of infancy (HOIs) and port-wine stains. Three pediatric otolaryngologists and facial plastic surgeons independently rated all of the pictures using our assessment tool.

SETTING:

Tertiary care pediatric hospital.

RESULTS:

Pulsed-dye laser therapy was performed in 22 patients, 17 with HOIs and 5 with port-wine stains. Patients with HOIs treated only by pulsed-dye laser showed, on average, a 50% to 75% improvement in color, 1% to 24%, improvement in thickness, and 1% to 24% improvement in size of the lesion. Eight patients with HOIs underwent surgery after laser therapy, and of these, 100% saw improvement in color, thickness, and size. Port-wine stains showed a 1% to 24% improvement in color and no improvement in thickness or size. Interrater reliability for questions 1 to 6 was 0.92, 0.92, 0.93, 0.91, 0.70, and 0.10, respectively.

CONCLUSIONS AND RELEVANCE:

Currently, no standardized or validated methods exist to evaluate results from intervention of pediatric facial HOIs and port-wine stains. Our assessment tool is reliable to assess patients with HOIs and port-wine stains who undergo pulsed-dye laser therapy and surgical reconstruction.

LEVEL OF EVIDENCE:

3.

• Authors: Javad A Sajan, Robert Tibesar, Noel Jabbour, Timothy Lander, Peter Hilger, James Sidman
• Journal: JAMA facial plastic surgery (JAMA Facial Plast Surg) 2013 Nov-Dec Vol. 15 Issue 6 Pg. 434-8 ISSN: 2168-6092 [Electronic] United States
• PMID: 24008312 (Publication Type: Evaluation Study, Journal Article, Video-Audio Media)

Topics

• Hemangioma (surgery)
• Humans
• Infant
• Lasers, Dye (therapeutic use)
• Observer Variation
• Outcome Assessment, Health Care (methods)
• Port-Wine Stain (surgery)
• Retrospective Studies
• Single-Blind Method
• Skin Neoplasms (surgery)
• Treatment Outcome