Surgical excision as the first therapeutic choice in single-muscle hemangiomas: a case series

Object: 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 the oncologic and functional outcomes of surgery as the ‎initial treatment of single-muscle hemangiomas.‎ Patients and Methods: Medical profiles of 17 patients with hemangiomas of vastus medialis for ‎whom surgery was selected as the initial treatment were reviewed. The indication for surgery was ‎a bothersome pain. Postoperative muscle strength was assessed with manual muscle testing (range ‎‎0-5). The postoperative pain was measured by a visual analog scale (VAS) for pain (range 0-10). ‎Lysholm-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. The surgery was performed as wide ‎resection in 13 cases and as 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. Postoperative pain was noticed in ‎four patients (VAS=1). Knee function was excellent in 13 patients and good in four patients. ‎Both of 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 could be considered the primary choice of treatment for single-muscle ‎hemangiomas. ‎