Immunohistochemical Puncture Staining Of GLUT-1,D2-40,CD31 And CD34 In The Application Of Kaposiform Hemangioendothelioma For Skin Grafting

ObjectiveKaposiform hemangioendothelioma is a severe hemangioma,associates with thrombocytopenia,coagulopathy and intravascular microthrombi.Due to the invasiveness of KHE tumors,it is often accompanied by life-threatening Kasabach-Mertitt syndrome,and the KHE tumor has a large area and spreads.After complete removal of the tumor,it is difficult to suture the incision and it is necessary to perform skin graft repair during the operation.In this study,GLUT-1,D2-40,CD31,and CD34 preoperative puncture staining are used to determine the extent and extent of tumor invasion to the epidermis,and a"balance point"is found between complete removal of the tumor and retention of normal skin.It is a multi-disciplinary combined surgical approach to perform orthopedic skin grafting instead of skin graft repair to reduce the risk of surgery and reduce postoperative complications in eligible patients.MethodsFrom December 2015 to July 2017,31 patients with Kaposiform hemangioendothelioma complicated with Kasabach-Mertitt syndrome met the inclusion criteria:Larger tumor area required skin grafting;platelet value<100×10~9/L.Before surgery,the patients’tumors are sampled by multi-point puncture.The immunostaining is used to diagnose whether the epidermis is damaged.The patients with normal epidermis are treated with orthotopic skin grafting,and the patients with damaged epidermis are treated with skin graft repair.After surgery 2 weeks,the skin graft survival is calculated as the percentage of total skin graft in each group,and record changes in platelet values at 1 week,4 weeks,12 weeks,and 24 weeks,wound drainage,surgery,and postoperative complications.ResultsThere is 31 cases of Kaposiform hemangioendothelioma with multiple pathological biopsy before surgery.There are 19 undamaged epidermis patients,11males and 8 females who underwent orthotopic skin grafting.There are 12 patients with damaged epidermis,8 males and 4 females who underwent skin graft repair.There were no statistically significant differences in the first-diagnosis age,sex ratio,tumor area,and tumor distribution between the two groups(P>0.05),thus they were comparable.In situ skin grafting and skin graft repair were divided into three groups according to the percentage of skin graft survival area.There was no significant difference between the three groups(p>0.05).In the skin graft repair group and the postoperative radical skin graft repair group,there was no significant difference in platelet changes between the1st,4th,12th,and 24th week of platelet counts(P>0.05).There are statistically significant differences in intraoperative blood loss,postoperative hemoglobin,albumin,and other surgical injury-related factors(P<0.05);there are statistically significant differences between the two groups in general conditions such as persistent fever,incision infection,and VSD drainage.(P<0.05).Conclusion1.In the Kaposiform hemangioendothelioma surgery,multi-point puncture GLUT-1,D2-40,CD31,CD34 immunostaining are used to diagnose whether the skin of the tumor was damaged and then choose skin grafting.The long-term platelets in the orthotopic skin grafts are all restored to normal.The cure rate of KM syndrome is not lower than that of skin graft repair.2.In the Kaposiform hemangioendothelioma surgery,multi-point puncture GLUT-1,D2-40,CD31,CD34 immunostaining are used to diagnose whether the skin of the tumor was damaged,the skin graft survival rate of in situ skin grafting is not lower than that of skin graft repair.3.In the Kaposiform hemangioendothelioma surgery,multi-point puncture GLUT-1,D2-40,CD31,CD34 immunostaining are used to diagnose whether the skin of the tumor was damaged,In situ orthotopic skin grafting is less traumatic and the postoperative complications are significantly better than traditional skin graft repair.