Intramuscular haemangiomas: Hookwire localization prior to surgical excision: Report of four cases

Background: Haemangiomas of skeletal muscle are a rare entity, although they are still noted to be one of the most common deep tissue tumours of the lower limb. All such lesions are benign with no recorded evidence of metastasis; but they are associated with a 17-20% local recurrence rate which is thought to be related to inadequate primary surgical excision rather than histological subtype. Methods: The present case series briefly discusses the pathophysiology, clinical manifestations, diagnostics, differential diagnosis and treatment modalities of intramuscular haemangiomas. The article then focuses on the recent introduction of ultrasound-guided hookwire localization, which has enabled a great increase in complete surgical excision, resulting in much lower rates of local recurrence and a more pleasing functional and cosmetic result because unnecessary dissection is avoided. Results: Preoperative ultrasound-guided hookwire localization of deep and often non-palpable intramuscular haemangiomas was very helpful in enabling a more complete surgical excision to be carried out. Conclusion: Hookwire localization using ultrasound guidance is an invaluable tool in directing the surgeon intraoperatively when excising deep intramuscular haemangiomas.