April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Management of Lymphatic Malformations

Airway involvement Once a tracheotomy has been performed, it is common towait un- til the airway is large enough to compensate for the initial cause of the obstruction. This process may take many years and it is common for children to need a tracheotomy until the teenage years and sometimes even longer. For this reason, the authors have embarked on a more aggressive decannulation program. Each patient’s airway is assessed and the site of obstruction is documented. Intralesional bleomycin injections with or without CO 2 laser ablation is performed periodically, usually every 3 months, in order to address the areas of obstruction 42 ( Fig. 10 ). Bleomycin is administered via a 27-gauge butterfly needle. With the patient in direct suspension and under direct vision,

Fig. 10. A child with airway involvement before ( top ) and after ( bottom ) multiple treat- ments with transmucosal bleomycin injections.

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