Surgical Excision as the First Therapeutic Choice in Single-muscle Hemangiomas: a Case Series

Background: Conservative management is generally the primary treatment for intramuscular hemangimas. However,many patients will require surgery later in their life, after suffering a long period of pain. We aimed to evaluate theoncologic and functional outcomes of surgery as the initial treatment of single-muscle hemangiomas.Methods: Medical profiles of 17 patients with hemangiomas of vastus medialis for whom surgery was selected asthe initial treatment were reviewed. The indication for surgery was a bothersome pain. Postoperative muscle strengthwas assessed with manual muscle testing (range 0-5). The postoperative pain was measured by a visual analog scale(VAS) for pain (range 0-10). Lyshölm-Tegner knee scoring scale was used for the evaluation of knee function.Results: The mean age of the patients was 25.9±8.6 years. Surgery was performed as wide resection in 13 cases andas marginal resection in 4 cases. At a mean follow-up of 55.76±30 months, two local recurrences (11.8%) were observed.At the last evaluation session, muscle strength grade was 5/5 in 13 patients and 4/5 in four patients. Postoperativepain was noticed in four patients (VAS=1). Knee function was excellent in 13 patients and good in four patients. Bothof the local recurrences occurred in marginally resected lesions. Three out of four cases with reduced muscle strength,postoperative pain, and reduced function were also treated with marginal resection.Conclusion: If a wide surgical margin is achievable without compromising the limb function, surgical resection couldbe considered as the primary choice of treatment for single-muscle hemangiomas.Level of evidence: IV