PEDIATRIC SURGERY Update

Lymphangiomas are congenital cystic tumors developing in the neck, axilla, chest and trunk. Characteristically they are composed of multiple sacs or loculation of lymphatic fluid. Cysts can vary in size from microcysts to large cystlike dilatations. The tumor can compress vital structure. The close relation of this benign tumor with vital structures reduces the chances of complete surgical excision in many cases. This has brought forth the need for alternative therapy such as sclerotherapy. Two such agents in use today for sclerosing lymphangiomas are OK-432 and fibrin glue sealant. OK-432 has not yet been approved by FDA. In 1988 fibrin glue successfully sealed a postoperative persistent lymphatic drainage in a chid after persistent drainage. Fibrin glue or sealant, an FDA approved product, consists of a mixture of fibrinogen, thrombin, a fibrinolysis inhibitor and calcium in separate vials. When mixed they form a viscous solution that sets into an elastic coagulum. Thrombin transforms fibrinogen into fibrin. The inhibitor prevents premature degradation of fibrin. Fibrin glue is adhesive, it is locally hemostatic and it regenerates tissue that favor the synthesis of collagen. The adhesive can effectively seal tissues surfaces and eliminate potential dead spaces. The technique for fibrin seal of lymphangiomas consists in percutaneous puncture of the cyst and aspiration of the whole content followed by introduction of fibrin sealant into the cavity. The amount injected consist of 10 to 15% of the suctioned volume. Treatment can be repeated. Results are very encouraging with few minor side effects such as erythema and cellulitis.