The Dorsal Scapular Artery Perforator Flap: A Complete Muscle-sparing Technique.

Cervical and thoracic spine reconstruction can be a difficult area to provide stable soft tissue coverage. Historically, trapezius myocutaneous flaps and trapezius muscle turnover flaps have proven to be reliable and versatile methods for the reconstruction of these areas. However, sequelae such as restriction of shoulder movement have been reported, as well as unsightly "humpback" contour deformities from turnover flap bulk. The use of the trapezius muscle for coverage has evolved to include descriptions of a trapezius perforator flap to address some of the issues of donor site morbidity, as it is described as a muscle-sparing technique. Although described as "muscle-sparing," these approaches nonetheless involve sacrifice of trapezius muscle overlying the pedicle as that musculature is "deroofed" and divided off the pedicle during dissection. In this article, we present a detailed technical description of our novel technique to the trapezius perforator flap using a dorsal scapular artery flap for spinal reconstruction that is truly, completely muscle-sparing. This technique may prove useful for those patients in which even minimal disruption of trapezius muscle fibers is undesirable.

Efficiency in DIEP Flap Breast Reconstruction: The Real Benefit of Computed Tomographic Angiography Imaging.

BACKGROUND: In deep inferior epigastric perforator (DIEP) flap breast reconstruction, many surgeons use preoperative imaging for perforator mapping as a method to plan the operation, reduce operative times, and potentially limit morbidity. This study compared operative times for specific portions of DIEP flap harvest with and without preoperative computed tomographic angiography imaging. METHODS: Two patient groups undergoing DIEP flap breast reconstruction were studied prospectively. In the experimental group, the harvesting surgeon was blinded to the preoperative computed tomographic angiography scan; in the control group, the harvesting surgeon assessed the scan preoperatively. Times for initial perforator identification, perforator selection, flap harvest time, and total procedure times were compared. Perforator choice was evaluated. Correlation of perforator choice preoperatively and intraoperatively was also performed. RESULTS: Times were recorded in 60 DIEP flaps (27 blinded and 33 unblinded). The nonblinded group was more efficient in all categories: time to first perforator identification (28.6 minutes versus 17.8 minutes; p < 0.0001), time to perforator decision-making (23.1 minutes versus 5.6 minutes; p < 0.0001), time to flap harvest (128 minutes versus 80 minutes; p < 0.0001), and total operative time (417 minutes versus 353 minutes; p < 0.001). Perforator location was not different between groups. Blinded intraoperative decisions correlated with preoperative imaging in 74 percent of flaps. More perforators were included in the blinded flaps compared to the nonblinded flaps (2.3 versus 1.4; p < 0.001). CONCLUSIONS: Use of preoperative computed tomographic angiography leads to decreased operative times, specifically with regard to perforator identification and perforator selection. Without preoperative computed tomographic angiography, surgeons included more perforators in the flaps. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Revisiting Anastomosis to the Retrograde Internal Mammary System in Stacked Free Flap Breast Reconstruction: An Algorithmic Approach to Recipient-Site Selection.

BACKGROUND: The authors present their stacked flap breast reconstruction experience to facilitate selection of either caudal internal mammary vessels or intraflap vessels for the second recipient anastomosis. METHODS: A retrospective review was conducted of multiflap breast reconstructions (double-pedicled deep inferior epigastric perforator, stacked profunda artery perforator, and stacked profunda artery perforator/deep inferior epigastric perforator) performed at the authors' institution from 2011 to 2018. Data collected included demographics, recipient vessels used, and intraoperative/postoperative flap complications. Complications were compared between cranial, caudal, and intraflap anastomoses. RESULTS: Four hundred stacked flaps were performed in 153 patients. Of 400 arterial anastomoses, 200 (50 percent) were to cranial internal mammary vessels, 141 (35.3 percent) were to caudal internal mammary vessels, and 59 (14.8 percent) were to intraflap vessels. Of 435 venous anastomoses, 145 (33.3 percent) were to caudal internal mammary vessels, 201 (46.2 percent) were to cranial internal mammary vessels, and 89 (20.5 percent) were to intraflap vessels. Intraoperative revision for thrombosis occurred in 12 of 141 caudal (8.5 percent), 14 of 20 cranial (7 percent), and seven of 59 intraflap (11.9 percent) arterial anastomoses (p = 0.373), and in none of caudal, three of 201 cranial (1.5 percent), and two of 89 intraflap (2.2 percent) venous anastomoses (p = 0.559). Postoperative anastomotic complications occurred in 12 of 400 flaps (3 percent) and were exclusively attributable to venous compromise; seven of 12 (58.3 percent) were salvaged, and five of 12 (41.7 percent) were lost. More lost flaps were caused by caudal [four of five (80 percent)] versus cranial [one of five (20 percent)] or intraflap (zero of five) thrombosis (p = 0.020). CONCLUSION: If vessel features are equivalent between the caudal internal mammary vessels and intraflap vessels, intraflap vessels should be used for second site anastomosis in stacked flap reconstructions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Avoiding Breach of Patient Confidentiality: Trial of a Smartphone Application That Enables Secure Clinical Photography and Communication.

BACKGROUND: To evaluate a smartphone application for clinical photography that prioritizes and facilitates patient security. METHODS: Ethics was obtained to trial the application Sharesmart. Calgary plastic surgeons/residents used the application for clinical photography and communication. Surveys gauging the application usability, incorporated consent process, and photograph storage/sharing were then sent to surgeons and patients. RESULTS: Over a 1-year trial period, 16 Calgary plastic surgeons and 24 residents used the application to photograph 84 patients. Half (56%) of the patients completed the survey. The majority of patients found the applications consent process acceptable (89%) and felt their photograph was secure (89%). Half (51%) of the surgeons/residents completed the survey and would use the application as is (67%) or with modifications (33%). The consent process was felt to be superior (73%) or equivalent (23%) to participant's prior methods and was felt to resolve issues present with current photography practices of secure transmission and storage of photographs by 100% and 95% of respondents, respectively. Perceived limitations of the application included difficulties in use with poor cellphone service or Internet, decreased speed compared to current practices, the lack of a desktop platform, video capability, and ability to transmit the photograph directly to the patient's medical record. CONCLUSIONS: A smartphone clinical photography application addresses the risks of patient confidentiality breach present with current photography methods; broad implementation should be considered.

HISTORIQUE: Évaluer une application de photographies cliniques pour téléphone intelligent, qui priorise et favorise la sécurité des patients. MÉTHODOLOGIE: Un comité d'éthique a approuvé l'essai de l'application Sharesmart. Des plasticiens et résidents de Calgary ont utilisé l'application pour leur prise de photographies cliniques et leurs communications. Les chirurgiens et les patients ont ensuite rempli des sondages évaluant l'ergonomie, le processus de consentement intégré ainsi que l'entreposage et le partage de photos. RÉSULTATS: Pendant une période d'essai d'un an, 16 plasticiens et 24 résidents de Calgary ont utilisé l'application pour photographier 84 patients. La moitié des patients (56 %) a rempli le sondage. La majorité des patients a trouvé le processus de consentement de l'application acceptable (89 %) et trouvaient que leur photographie était sécurisée (89 %). La moitié des chirurgiens et des résidents (51 %) ont rempli le sondage et utiliseraient l'application telle quelle (67 %) ou avec des modifications (33 %). Ils considéraient le processus de consentement comme supérieur (73 %) ou équivalent (23 %) aux méthodes qu'ils avaient l'habitude d'utiliser, et 100 % et 95 % d'entre eux, respectivement, trouvaient que l'application réglait les problèmes de transmission sécuritaire et d'entreposage liés aux pratiques photographiques actuelles. Les limites perçues de l'application incluaient les difficultés d'utilisation en cas de service cellulaire ou Internet médiocre, la diminution de la vitesse par rapport aux pratiques actuelles, l'absence de plateforme bureautique, la capacité vidéo et la capacité de transmettre la photographie directement dans le dossier médical du patient. CONCLUSIONS: Une application de photographies cliniques pour téléphone intelligent aborde les risques de bris de confidentialité des patients que présentent les modes de photographie actuels; il faudrait en envisager la mise en œuvre généralisée.

Improved Recovery Experience Achieved for Women Undergoing Implant-Based Breast Reconstruction Using an Enhanced Recovery after Surgery Model.

BACKGROUND: Enhanced recovery after surgery was compared with traditional recovery after surgery for postmastectomy alloplastic breast reconstruction. METHODS: Length of stay, emergency room visits, and complications within 30 days of surgery were compared among three groups: traditional recovery after surgery, transition (some elements of enhanced recovery protocol, not transitioned to outpatient care), and enhanced recovery after surgery (day surgery, provided with standardized perioperative education and multimodal analgesia). Prospective data collection allowed quality-of-recovery assessment using a validated questionnaire for enhanced recovery/transition groups. Results were statistically analyzed (analysis of variance/chi-square). RESULTS: The traditional recovery, transition, and enhanced recovery cohorts comprised 29, 11, and 29 patients, respectively. No significant differences were present regarding age, smoking status, preoperative radiation, single stage direct-to-implant versus tissue expander, bilateral versus unilateral surgery, or immediate versus delayed reconstruction among groups. Average length of stay was 1.6 nights in both the traditional recovery and transition groups, compared with 0 nights in the enhanced recovery group (p < 0.001). Enhanced recovery patients had less severe pain (p = 0.02) and nausea (p = 0.01), and better enjoyed their food (p = 0.0002) and felt more rested (p = 0.02) than their transition counterparts. There were no differences in the number of emergency room visits among the three groups (p = 0.88). There was no difference in the rate of hematoma (p = 0.36), infection requiring intravenous antibiotics (p = 0.36), or infection requiring explantation (p = 0.36) among the three groups. CONCLUSION: An enhanced recovery protocol for alloplastic breast reconstruction treated patients safely, with improved patient satisfaction and same-day discharge and with no increase in complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Balancing the Need for Clinical Photography With Patient Privacy Issues: The Search for a Secure SmartPhone Application to Take and Store Clinical Photographs.

BACKGROUND: Physicians are increasingly using smartphones to take clinical photographs. This study evaluates a smartphone application for clinical photography that prioritizes and facilitates patient security. METHODS: Ethics approval was obtained to trial a smartphone clinical photography application, PicSafe Medi. Calgary plastic surgeons and residents used the application to obtain informed consent and photograph patients. Surveys gauging the application's usability, consent process, and photograph storage/sharing were then sent to surgeons and patients. RESULTS: Over a 6-month trial period, 15 plastic surgeons and residents used the application to photograph 86 patients. Over half of the patients (57%) completed the survey. The majority of patients (96%) were satisfied with the application's consent process, and all felt their photographs were secure. The majority (93%) of surgeons/residents completed the survey. The application was felt to overcome issues with current photography practices: inadequate consent and storage of photographs (100%), risk to patient confidentiality (92%), and unsecure photograph sharing (93%). Barriers to regular use of the application included need for cellphone service/Internet (54%), sanitary concerns due to the need for patients to sign directly on the phone (46%), inability to obtain proactive/retroactive consent (85%), and difficulty viewing photographs (80%). The majority of surgeons (85%) believe a smartphone application would be suitable for clinical patient photography, but due to its limitations, only 23% would use the trialed application. CONCLUSIONS: A smartphone clinical photography application addresses the patient confidentiality risks of current photography methods; however, limitations of the trialed application prevent its broad implementation.

HISTORIQUE: Les médecins utilisent de plus en plus leur téléphone intelligent pour prendre des photographies cliniques. La présente étude vise à évaluer une application photographie clinique pour téléphone intelligent qui priorise et favorise la sécurité des patients. MÉTHODOLOGIE: Les auteurs ont obtenu l'approbation éthique nécessaire pour mettre à l'essai PicSafe Medi©, une application photographie clinique pour téléphone intelligent. Des plasticiens et des résidents de Calgary l'ont utilisée pour obtenir le consentement éclairé des patients et les photographier. Les plasticiens et les patients ont ensuite reçu un sondage pour évaluer la facilité d'utilisation de l'application, le processus de consentement et le processus d'entreposage et de partage des photos. RÉSULTATS: Sur une période d'essai de six mois, 15 plasticiens et résidents ont utilisé l'application pour photographier 86 patients. Plus de la moitié des patients (57 %) ont rempli le sondage. La majorité d'entre eux (96 %) étaient satisfaits du processus de consentement de l'application et avaient l'impression que leurs photographies étaient sécurisées. La plupart des plasticiens et des résidents (93 %) ont rempli le sondage. Ils trouvaient que l'application réglait des problèmes liés aux pratiques actuelles de photographie : consentement et entreposage inadéquats (100 %), risque de ne pas respecter la confidentialité des patients (92 %) et partage non sécurisé des photographies (93 %). Les obstacles à l'utilisation régulière de l'application incluaient la nécessité d'avoir accès à un service de téléphonie cellulaire ou à Internet (54 %), les problèmes d'hygiène puisque les patients devaient signer directement sur le téléphone (46 %), l'impossibilité d'obtenir un consentement proactif ou rétroactif (85 %) et la difficulté à visualiser les photographies (80 %). La majorité des chirurgiens (85 %) trouvaient qu'une application pour téléphone intelligent conviendrait à la prise de photos cliniques des patients, mais à cause de ses limites, seulement 23 % utiliseraient celle mise à l'essai. CONCLUSIONS: Une application photographie clinique pour téléphone intelligent résout les risques potentiels des modes de photographie actuels liés à la confidentialité des patients, mais les limites de celle à l'essai en empêchent l'utilisation généralisée.

Enhanced Recovery After Surgery (ERAS) Protocol Enables Safe Same-Day Discharge After Alloplastic Breast Reconstruction.

BACKGROUND: To compare enhanced recovery after surgery (ERAS) with traditional recovery after surgery (TRAS) for patients undergoing alloplastic breast reconstruction. METHODS: A retrospective chart review of 2 patient groups (ERAS and TRAS) undergoing alloplastic breast reconstruction was performed. Data were collected from 2012 to 2013 (TRAS) and from 2013 to 2016 (ERAS). The ERAS protocol included day surgery, multimodal analgesia, and preoperative anti-emetic. The TRAS pathway involved overnight admission, narcotic-based analgesia, and no preoperative anti-emetic. Demographics, operative variables, and complications were compared between groups. RESULTS: Seventy-eight ERAS patients and 78 TRAS patients were included. Length of stay was shorter for ERAS patients (0.38 nights ERAS and 1.45 nights TRAS; P < .001). The ERAS patients underwent significantly more bilateral surgery (80.8% ERAS and 55.1% TRAS; P < .001), immediate reconstruction (98.6% ERAS and 89.3% TRAS; P = .004), and had more implants versus expanders placed (66% [93/141] ERAS and 24.8% TRAS; P < .001). There were no differences in the number of post-operative emergency department visits (8% ERAS and 14% TRAS; P = .2) and readmissions (8% ERAS and 3.8% TRAS; P = .3) between the groups. There was no difference in the rate of hematoma (0.7% ERAS and 0% TRAS; P = .35), infection requiring explantation (1.4% ERAS and 0.8% TRAS; P = .65), infection requiring outpatient IV antibiotics (1.4% ERAS and 2.5% TRAS; P = .53), and infection requiring IV antibiotics and readmission (2.1% ERAS and 1.7% TRAS; P = .78) between the groups. There were no differences in the number of minor complications (22% ERAS and 23% TRAS; P = .82). CONCLUSION: The ERAS protocol for alloplastic breast reconstruction is safe, without increased readmission or complication rates compared to TRAS, and significantly decreased length of stay.

HISTORIQUE: Comparer la récupération rapide après la chirurgie (RRAC) à la récupération habituelle après la chirurgie (RHAC) chez les patientes qui subissent une récupération mammaire alloplastique. MÉTHODOLOGIE: Les chercheurs ont procédé à l'analyse rétrospective des dossiers de deux groupes de patientes (RRAC et RHAC) qui subissaient une reconstruction mammaire alloplastique. Ils ont recueilli les données de 2012 et 2013 (RHAC) et de 2013 à 2016 (RRAC). Le protocole RRAC incluait une chirurgie d'un jour, une analgésie multimodale et un anti-émétique préopératoire. La voie RHAC incluait l'admission d'une nuit, une analgésie narcotique et l'absence d'anti-émétique préopératoire. Les chercheurs ont comparé les données démographiques, les variables opératoires et les complications entre les groupes. RÉSULTATS: Au total, 78 patientes RRAC et 78 patientes RHAC ont participé à l'étude. Les patientes RRAC étaient hospitalisées moins longtemps (0,38 nuit RRAC, 1,45 nuit RHAC, p<0,001). Les patientes RRAC ont subi beaucoup plus de chirurgies bilatérales (80,8 % RRAC, 55,1 % RHAC, p<0,001) et de reconstructions immédiates (98,6 % RRAC, 89,3 % RHAC, p=0,004) et se sont fait installer plus d'implants que d'expanseurs (66 % RRAC [93 sur 141], 24,8 % RHAC, p<0,001). Les groupes ne présentaient pas de différence quant au nombre de rendez-vous postopératoires à l'urgence (8 % RRAC, 14 % RHAC, p=0,2) et de réhospitalisations (8 % RRAC, 3,8 % RHAC, p=0,3). Ils ne présentaient pas de différences quant au taux d'hématomes (0,7 % RRAC, 0 % RHAC, p=0,35) ni d'infection exigeant l'explantation (1,4 % RRAC, 0,8 % RHAC, p=0,65), la prise d'antibiotiques IV ambulatoires (1,4 % RRAC, 2,5 % RHAC, p=0,53) ou la prise d'antibiotiques IV et une réhospitalisation (2,1 % RRAC, 1,7 % RHAC, p=0,78). Le nombre de complications mineures ne différait pas davantage (22 % RRAC, 23 % RHAC, p=0,82). CONCLUSION: Le protocole RRAC de reconstruction mammaire alloplastique est sécuritaire, n'accroît pas le taux de réhospitalisations ou de complications par rapport à la RHAC et réduit le séjour hospitalier de manière significative.

Should 'smart phones' be used for patient photography?

BACKGROUND: Within the field of plastic surgery, clinical photography is an essential tool. 'Smart phones' are increasingly being used for photography in medical settings. OBJECTIVE: To determine the prevalence of smart phone use for clinical photography among plastic surgeons and plastic surgery residents in Canada. METHODS: In 2014, a survey was distributed to all members of the Canadian Society of Plastic Surgeons. The questions encompassed four main categories: smart phone use for clinical photos; storage of photos; consent process; and privacy issues. The survey participation rate was 27% (147 of 545) with 103 surgeons and 44 residents. In total, 89.1% (131 of 147) of respondents have taken photographs of patients using smart phones and 57% (74 of 130) store these photos on their phones. In addition, 73% (74 of 102) of respondents store these photos among personal photos. The majority of respondents (75% [106 of 142]) believe obtaining verbal consent before taking clinical photographs is sufficient to ensure privacy is respected. Written consent is not commonly obtained, but 83% (116 of 140) would obtain it, if it could be done more efficiently. Twenty-six percent (31 of 119) of respondents have accidentally shown a clinical photograph on their phone to friends or family. A smart phone application that incorporates a written consent process, and allows photos to be immediately stored externally, is perceived by 59% (83 of 140) to be a possible way to address these issues. CONCLUSION: Smart phones are commonly used to obtain clinical photographs in plastic surgery. There are issues around consent process, storage of photos and privacy that need to be addressed.

HISTORIQUE: La photographie clinique est un outil essentiel en chirurgie plastique. Les « téléphones intelligents ¼ sont de plus en plus utilisés pour prendre des photos dans un contexte médical. OBJECTIF: Déterminer la prévalence d'utilisation du téléphone intelligent pour prendre des photos cliniques chez les chirurgiens plasticiens et les résidents en chirurgie plastique du Canada. MÉTHODOLOGIE: En 2014, tous les membres de la Société canadienne des chirurgiens plasticiens ont reçu un sondage. Les questions portaient sur quatre grandes catégories : l'utilisation du téléphone intelligent pour prendre des photos cliniques, l'entreposage des photos, le processus de consentement et le respect de la vie privée. Le taux de participation s'est élevé à 27 % (147 sur 545), soit 103 chirurgiens et 44 résidents. Au total, 89,1 % des répondants (131 sur 147) prennent des photos des patients à l'aide de leur téléphone intelligent, et 57 % (74 sur 130) les conservent dans leur téléphone. De plus, 73 % des répondants (74 sur 102) les entreposent avec leurs photos personnelles. La majorité des répondants (75 % [106 sur 142]) pensent que l'obtention d'un consentement verbal avant la prise des photos cliniques suffit pour garantir le respect de la vie privée. Le consentement écrit est peu obtenu, mais 83 % (116 sur 140) l'obtiendraient si ce pouvait être fait avec plus d'efficacité. Par ailleurs, 26 % des répondants (31 sur 119) ont montré accidentellement des photos cliniques entreposées dans leur téléphone à leurs amis ou leur famille. Une application pour téléphone intelligent qui intègre un processus de consentement écrit et l'entreposage externe immédiat des photos est perçue par 59 % des répondants (83 sur 140) comme un moyen possible de régler ces problèmes. CONCLUSION: Les téléphones intelligents sont très utilisés en chirurgie plastique pour obtenir des photographies cliniques. Il faut régler certains problèmes liés au processus de consentement, à l'entreposage des photos et au respect de la vie privée.

Beta-blockers for the treatment of problematic hemangiomas.

OBJECTIVE: To examine treatment indications, efficacy and side effects of oral beta-blockers for the treatment of problematic hemangiomas. METHODS: A retrospective review of patients with hemangiomas presenting to the Alberta Children's Hospital Vascular Birthmark Clinic (Calgary, Alberta) between 2009 and 2011 was conducted. The subset of patients treated with oral beta-blockers was further characterized, investigating indication for treatment, response to treatment, time to resolution of indication, duration of treatment, occurrence of rebound growth and side effects of therapy. RESULTS: Between 2009 and 2011, 311 new patients with hemangiomas were seen, of whom 105 were treated with oral beta-blockers. Forty-five patients completed beta-blocker treatment while the remainder continue to receive therapy. Indications for treatment were either functional concerns (68.6%) or disfigurement (31.4%). Functional concerns included ulceration (29.5%), periocular location with potential for visual interference (28.6%), airway interference (4.8%), PHACES syndrome (3.8%), auditory interference (0.95%) and visceral location with congestive heart failure (0.95%). The median age at beta-blocker initiation was 3.3 months; median duration of therapy was 10.6 months; and median maximal treatment dose was 1.5 mg/kg/day for propranolol and 1.6 mg/kg/day for atenolol. Ninety-nine patients (94.3%) responded to therapy with size reduction, colour changes, softened texture and/or healing of ulceration. Rebound growth requiring an additional course of therapy was observed in 23 patients. Side effects from beta-blockers included cool extremities (26.7%), irritability (17.1%), lower gastrointestinal upset (14.3%), emesis (11.4%), hypotension (10.5%), poor feeding (7.6%), lethargy (4.8%), bronchospasm (0.95%) and rash (0.95%). Side effects did not result in complete discontinuation of beta-blocker treatment in any case; however, they prompted a switch to a different beta-blocker preparation in some cases. Resolution of the primary indication, requiring a median time of three months, occurred in 87 individuals (82.9%). CONCLUSIONS: Treatment of infantile hemangiomas with oral beta-blocker therapy is highly effective and well tolerated, with more than 94% of patients demonstrating a response to treatment and 90% showing resolution of the primary functional indication for treatment.

OBJECTIF: Examiner les indications thérapeutiques, l'efficacité et les effets secondaires des bêtabloquants par voie orale pour traiter les hémangiomes problématiques. MÉTHODOLOGIE: Les chercheurs ont procédé à une analyse rétrospective des patients ayant des hémangiomes qui ont consulté à la clinique des angiomes vasculaires de l'Alberta Children's Hospital de Calgary, en Alberta, entre 2009 et 2011. Le sous-groupe de patients traités à l'aide de bêtabloquants par voie orale était caractérisé de manière plus détaillée, puisqu'on examinait l'indication thérapeutique, la réponse au traitement, le délai jusqu'à la résolution de l'indication, la durée du traitement, l'occurrence d'une excroissance de rebond et les effets secondaires du traitement. RÉSULTATS: Entre 2009 et 2011, 311 nouveaux patients ayant des hémangiomes ont consulté, dont 105 ont été traités à l'aide de bêtabloquants par voie orale. Quarante-cinq patients ont terminé le traitement, tandis que les autres continuent d'être traités. Les indications thérapeutiques étaient des préoccupations d'ordre fonctionnel (68,6 %) ou le préjudice esthétique (31,4 %). Les préoccupations d'ordre fonctionnel incluaient une ulcération (29,5 %), un foyer périoculaire avec un potentiel d'interférence visuelle (28,6 %), une interférence avec les voies aériennes (4,8 %), un syndrome PHACES (3,8 %), une interférence auditive (0,95 %) et un foyer viscéral avec une insuffisance cardiaque congestive (0,95 %). Les patients avaient un âge médian de 3,3 mois au début du traitement aux bêtabloquants, et le traitement avait une durée médiane de 10,6 mois. La dose maximale médiane du traitement était de 1,5 mg/kg/jour s'ils prenaient du propranolol et de 1,6 mg/kg/jour s'ils prenaient de l'aténolol. Quatre-vingt-dix-neuf patients (94,3 %) ont répondu au traitement par une diminution de la dimension, un changement de la couleur, une amélioration de la texture ou une guérison de l'ulcération. Chez 23 patients, une excroissance de rebond a exigé une cure supplémentaire. Les effets secondaires des bêtabloquants incluaient des membres froids (26,7 %), l'irritabilité (17,1 %), des troubles du bas de l'intestin (14,3 %), des vomissements (11,4 %), une hypotension (10,5 %), une alimentation insuffisante (7,6 %), une léthargie (4,8 %), un bronchospasme (0,95 %) et une éruption (0,95 %). Les effets secondaires n'ont jamais suscité l'interruption complète du traitement aux bêtabloquants, mais ont parfois donné lieu à un transfert vers une nouvelle préparation de bêtabloquants. Chez 87 patients (82,9 %), les chercheurs ont constaté la résolution de l'indication primaire, dans un délai médian de trois mois. CONCLUSIONS: Le traitement des hémangiomes infantiles à l'aide de bêtabloquants par voie orale est très efficace et bien toléré. En effet, plus de 94 % des patients répondent au traitement et 90 % présentent une résolution de l'indication thérapeutique fonctionnelle primaire.