Venous and capillary malformations and other low-flow vascular malformations are not rare in clinical practice, and about 40% of them are distributed in the head and neck region [1]. surgery is often difficult to completely remove the lesion and has a high recurrence rate. 2 cases were cured by surgery combined with local percutaneous injection of hypertonic glucose under ultrasound followed by thrombin in our hospital from July to September 2007, which are reported below. 1. Clinical data and methods 1.1. General material The patients were all female, aged 16 and 11 years old, respectively. They presented to the clinic with huge masses in the occipital region of the neck and right shoulder. The cystic masses were located in the neck and right shoulder-occipital area, with sizes of 15 cm × 38 cm × 46 cm and 10 cm × 12 cm × 6 cm, respectively, and were significantly enlarged with increased tension after lying down. Some of the skin was blue-purple in color, no pulsation was detected, and the skin temperature was normal. CT angiography showed venous malformation (Figure 1,3). The blood count and coagulation time were normal. 1.2. Methods Most of the hemangioma was removed surgically and local skin grafting was performed. One week after surgery, a trocar needle connected to a tee was punctured into the residual tumor under ultrasound positioning, and after dark red venous blood was retrieved, the trocar was compressed around the puncture point to make the tumor atrophy, and under ultrasound guidance, 10-30 ml of 50% glucose was injected within 5-10 s. The blood flow was slowed down under ultrasound, followed by rapid injection of freshly prepared thrombin in saline connected to another syringe of the tee. Thrombin (Shanghai First Biochemical Pharmaceutical Co., Ltd.) solution (200~500u/2~5ml) connected to the other syringe of the tee was injected, and the needle was quickly withdrawn and then slightly compressed. The changes in the same location before and after treatment were observed and compared 30 min and 24 h after treatment, respectively (Figure 2,4). The next injection was given after an interval of 1-2 d. 2. Results Eight injections were given in the first case and three injections in the second case. Rapid coagulation of blood flow and thrombus formation within the residual vascular malformation was seen on ultrasound (Figure 2b,4b), and the patient had no special postoperative discomfort. no recurrence of hemangioma was seen in the treated area on review at 8 and 9 months. For vascular malformations located in special locations such as the neck and pharynx, domestic and foreign scholars have tried to supplement with laser and sclerosing agent injection to improve safety and prevent recurrence, but all of them are unsatisfactory. Thrombin treatment for pseudoaneurysm has been reported [2, 3], and most scholars believe that thrombin treatment is safe, but Forbes et al [4] reported a case of thrombin leading to femoral artery embolism. So its possible spillover of angiodysplasia leading to embolism limits the wide application of this method. We have successfully treated pseudoaneurysms of the subclavian artery with hypertonic glucose supplemented with a small dose of thrombin (167u) by local injection [5]. Surgery should be performed to remove as much diseased tissue as possible, and the deep side of the mandibular angle must be handled with care, which is often tricky in case of bleeding. Because the patient’s malformed lumen is thick and rich in blood return, as in case 2 with a combined dilated left internal jugular vein, which was resected intraoperatively, preoperative local injections are ineffective and risky, so thrombin injections are given postoperatively into the body of the residual hemangioma. To avoid embolism caused by thrombin or the formation of thrombus entering the circulation, it is advisable to first compress the area around the injection site with a collar, and then open the compressed area after the thrombin has responded adequately. It is advisable to inject small amounts several times, in stages and subdivisions, and care should be taken to avoid accidental injection into the surrounding normal vessels. In conclusion, we believe that local injection of hypertonic glucose supplemented with small doses of thrombin to cause local thrombosis to occlude or narrow the malformed vessels, combined with surgical treatment before injection, is safe and effective, especially for complex giant low-flow vascular malformations of the head and neck and can effectively reduce postoperative recurrence. a. A large mass was seen in the left neck and shoulder and occipital region, right to the anterior trachea, above deep into the left deep mandibular surface, below in the sternoclavicular joint and left clavicle, extending backward to the left dorsal shoulder and occipital region. b. ENT endoscopy showed a purple-red mass in the left nasopharynx, oropharynx, soft palate and epiglottis, with vascularization visible on the surface. The uvula was pushed to the right side; c. CTA showed that the hemangioma penetrated from the left clavicle upward into the skull base and medially into the trachea and esophageal space, and multiple calcification shadows were visible inside, and multiple trophoblastic vessels from the external cervical and left subclavian arteries were seen entering the tumor; d. 8 thrombin injections and skin grafting after 2 months of trauma; a. Ultrasound showed a blood flow spectrum; b. Thrombus formation was already present at the same site 24 h after thrombin injection; a. b. CTA showed a large soft mass in the left neck, with normal skin color and a visible vein stone; b. CTA showed a hemangioma from the left clavicle upward into the skull base and medially into the trachea and esophagus; c. The tumor and a thick inferior internal jugular vein were seen in the venous phase of neck angiography; d. The neck was reviewed 8 months after surgery; a. Ultrasound showed a blood flow spectrum; b. The same site had thrombosis 30 min after thrombin injection. thrombosis.