Self-compounded Doxycycline Sclerotherapy for the Treatment of Lymphatic Malformations in Low-Resource Settings
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SURGERY IN LOW AND MIDDLE INCOME COUNTRIES
Self-compounded Doxycycline Sclerotherapy for the Treatment of Lymphatic Malformations in Low-Resource Settings David A. Shaye2,1 • Ciersten A. Burks1 • Shekhar K. Gadkaree1 • Isaie Ncogoza2 Gratien Tuyishimire2 • Victor Nyabyenda2 • Aaron Gassore2
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Accepted: 14 June 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Congenital anomalies are one component of the overwhelming surgical disease burden in low- and middle-income countries (LMICs). Lymphatic malformations (LMs) are a common congenital deformity of the head and neck in which the utilization of sclerotherapy may avoid surgery and yield superior outcomes. To be useful in LMICs, sclerosing agents must be widely available, inexpensive, and effective. Methods A retrospective review of 10 pediatric patients with macrocystic or mixed LMs who were treated with selfcompounded doxycycline sclerotherapy at Rwanda’s Central University Teaching Hospital of Kigali was performed. Doxycycline oral tablets were crushed by hand, mixed with normal saline at a concentration of doxycycline 10 mg/ mL, and injected directly into LMs of the head and neck. Results Ten pediatric patients underwent 21 sclerotherapy sessions with a mean of 2.1 sessions per patient (SD 1.3, range 1–5). Of the 8 patients that were seen in follow-up, all achieved at least 80% resolution, 6 of 8 achieved 100% resolution, and none required surgery. One patient developed an infection at the injection site which resolved with antibiotics. Conclusions Self-compounded doxycycline sclerotherapy is a safe, effective, and widely available treatment option for sclerotherapy of LMs in LMICs.
Introduction Congenital anomalies are responsible for an alarming 57.7 million disability-adjusted life years (DALYs) worldwide. [1] Lymphatic malformations (LMs) are congenital, cystic lesions that occur most commonly in the head and neck at a rate of 1:2000–1:4000 live births [2–6] (Fig. 1). Abnormal
& David A. Shaye [email protected] 1
Facial Plastics and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
2
Department of Otolaryngology, Central University Teaching Hospital, Kigali, Rwanda
development of lymphatic channels results in macrocystic, microcystic, or mixed lesions lined by vascular endothelium [7]. Spontaneous resolution is rare (3%), and without treatment, infection or hemorrhage can compress adjacent structures in the head and neck, including the airway [8, 9]. Surgical resection has historically been the mainstay of treatment, but is technically challenging and fraught with complications due to the proximity of vital neurovascular structures [10]. Sclerotherapy has emerged as a preferential therapeutic option, particularly in the management of macrocytic lesions [11]. Sclerotherapy relies on the infiltration of an inflammatory agent that scars, contracts, and eventually consolidates the vascular endothelium. A wide variety of sclero
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