Plastic and Maxillofacial Surgery


  • Introduction

    Our approach to research is holistic. While we have developed a number of research projects to understand why vascular anomalies occur and how we can use that information to develop new treatment options, we also have a number of research projects aimed at improving the quality of life in vascular anomalies patients. Our research team has made efforts to link with the vascular anomalies patients and their families and to listen to their concerns and answer some of their questions that would ease the burden of living with vascular anomalies.

    Our Vascular Anomalies Clinic at the Royal Children Hospital has close ties with the Murdoch Childrens Research Institute Vascular Biology Research Laboratory. The focus of the laboratory research is on blood vessel and lymphatic vessel development, growth and changes in health and vascular anomalies. The laboratory is strongly focused on genetic and cell biology studies that could tell the patients how a specific vascular anomaly has developed and what is the future for new treatment options. In addition, our laboratory is involved in a number of clinical research projects aimed at more precisely defining unknown diagnoses and understanding how treatments affect the biology of vascular anomalies.   We also have strong links to other laboratories around the world studying vascular anomalies.

    Our clinical projects revolve around improving the quality of life of our vascular anomalies patients and conducting studies that can answer patient’s concerns such as ‘why is propranolol not effective for my child’s haemangioma?’ or ‘why do we use certain wound dressings to treat infantile haemangioma ulcers?’

    Our team

    Dr Zerina Lokmic is the Head of the Vascular Biology Laboratory at the Murdoch Childrens Research Institute. She is also a clinical nurse consultant for vascular anomalies at the Department of Plastic and Maxillofacial Surgery at the Royal Children’s Hospital. Zerina received her doctorate in biomedicine in 2005 from the University of Melbourne’s Department of Surgery. She trained as a post-doctoral research fellow at the Institute for Physiological Chemistry and Pathobiochemistry at the University of Munster, Germany. Zerina obtained a Masters in Nursing Science degree in 2010 also from the University of Melbourne. In her role as a nurse and a scientist she provides strong scientific and nursing support for the growing vascular anomalies clinical program at the Royal Children’s Hospital and Murdoch Childrens Research Institute and strives to improve clinical practice and policy development aimed at improving health outcomes of children with vascular anomalies.

    Ms Theresa Connor joined the vascular Biology Laboratory in 2014 in a role of a senior research assistant. Theresa completed her undergraduate training at the Simon Fraser University, Vancouver, Canada.

    Prof Tony Penington is a group leader in the Vascular Biology Research Laboratory. He completed his medical degree in 1985 and his surgical training in 1995. He was awarded an MD degree by the University of Melbourne in 2008 and became the Jigsaw professor of Plastic and Reconstructive Surgery in 2012. In addition to his busy clinical practice, Tony has a strong research interest in vascular anomalies and leads a clinical research program aimed at improving plastic surgery practice ensuring our patients receive the highest level of care.

    A/Prof Rod Philips is a paediatric skin specialist and a clinical researcher. He is a co-ordinator of the Royal Children's Hospital Vascular Anomalies Centre. Rod has greatly contributed to our understanding of propranolol effect in treatment of infantile haemangioma. He actively participates in the vascular biology laboratory discussions and project development.

    How can I support research?

    We welcome your participation in our research. For many of the laboratory-based research projects you can contribute by donating tissue samples at the time of surgery that would otherwise be discarded. At the time of consultation, you will be asked if you wish to participate in an ethically-approved research study. If you are willing to contribute, you will be asked to read a consent form and sign it in the presence of a person who is not involved in your clinical management.

    We encourage you to visit this page and examine the research projects available and contact us if you wish to participate in any of the research projects. For some projects you may receive a letter inviting you to participate in some way. We are also keen to hear from you if you have any specific questions that you may need answered but that at the moment we have no information about. Such questions can become a research topic that would help vascular anomalies patients around the world.

    Current biomedical research projects:

    Project I: Propranolol resistance in infantile haemangioma
    Assoc. Prof Rod Phillips, Dr Zerina Lokmic, Prof Tony Penington

    Hemangioma of infancy is a common benign tumour of infancy which appears soon after birth. It affect about 10% of Caucasian newborns. In most cases it regresses spontaneously, but sometimes these tumours can cause complications if found at a site important for body function, such as airway or eye. Haemangioma of infancy likely to cause such complications is treated with propranolol. In most cases this treatment is highly successful but about 10% of children do not respond to this treatment. The goal of our clinical and lab –based research is to understand why this occurs.

    Project II: The biology of lymphatic malformations
    Dr Zerina Lokmic, Prof Tony Penington

    Our research aims to identify and understand cause and consequence of lymphatic malformations.  To do this we isolate from tissue removed at surgery, the endothelial cells, the cyst lining cells which we believe are altered in this condition.  We grow and study these cells in the laboratory.  We hope to understand how lymphatic malformations develop and identify specific molecules that might be the targets of future drug treatments.

    Project III: The role of angiopoietin family in the pathogenesis of lymphatic malformations
    Dr Zerina Lokmic, Prof Tony Penington

    Our previous studies of lymphatic malformation endothelial cells have identified a number of molecules that seem to be present in too great or too little amount compared to normal cells and may therefore one day be a target for treatment.   One such group of molecules are the Angiopoietins and their TIE receptors (TIE-1 and TIE-2) which  form an important signalling system in development of the lymphatic system.   We are using a range of laboratory techniques to study the role of angiopoietins and their TIE receptors in cells grown from human Lymphatic Malformations.

    Clinical research projects:

    We will post many of our clinical research projects on our webpage where we will ask you to contact us if you think that you can help us with these projects. Many of them will involve short on-line surveys or interviews. With each project we will endeavour to make it as convenient as possible for you.

    Wound dressings in ulcerated infantile haemangioma - can we do better?
    Principal investigator: Dr Zerina Lokmic

    This project is aimed at investigating our current wound management practice of infantile haemangioma ulcers. In particular, our aim is to decrease the variability in approach to wound dressing strategy and to develop a clinical protocol guideline that will help nurses to optimally manage ulcerated infantile haemangioma.

    Assessing the information needs of families with Vascular Anomalies whose child is in a particular age group.
    Principal investigators: Dr Zerina Lokmic, Ms Louisa Di Pietro, Dr Nicky Kilpatrick (?)

    This project will be undertaken by Ms Lucie Hallenstein. Lucie will interview the families to determine the information needs of families whose children were diagnosed with vascular anomalies. In this project families will be sent an invitation letter inviting them to participate in a structured interview.

    Quality of Life: Effect of treatment on Children with vascular anomalies
    Principal investigator: Dr Zerina Lokmic, Prof Tony Penington, Prof Fiona Newall


    Dr Zerina Lokmic
    Vascular Biology Research Laboratory,
    Murdoch Children’s Research institute
    50 Flemington Rd
    Parkville, 3052

    Selected publications:

    • Lokmic, Z., Mitchell GM, Koh, N, Bastiaanse J, Gerrand Y-W, Williams, E.D. Penington A.J. Isolation of human lymphatic malformation endothelial cells, their in vitro characterization and in vivo survival in a mouse xenograft model. Angiogenesis, 2014;17(1):1-15
    • Phillips R, Lokmic Z, Crock C, Penington A. Failed treatment of ulcerated haemangiomas. Archives of Disease in Childhood, 2014;50(8):619-25.
    • Phillips RJ, Penington AJ, Bekhor PS, Crock CM. Use of propranolol for treatment of infantile haemangiomas in an outpatient setting. J Paediatr Child Health. 2012 Oct;48(10):902-6.
    • Song, J, Lokmic Z, (co-first author) Lammermann T, Rolf J, Wu, C, Zhang X, Hallmann R, Hannocks , M, Horn N, Ruegg MA, Sonnenberg A, Georges-Labouesse E, Winkler TH, Kearney JF, Cardell S, Sorokin L. The Extracellular Matrix of Secondary Lymphoid Organs Impacts on B Cell Fate and Survival, PNAS 2013 Jul 30;110(31):E2915-24.
    • Bastiaanse J, Lokmic Z, Williams RA, Penington AJ: Sympathetic innervation of glomus tumours. Plastic and Reconstructive Surgery 2013 Dec;132(6):1088e-91e2013.
    • Worner M, Poore S, Tilkorn D, Lokmic Z, Penington AJ. A low-cost, small volume circuit for autologous blood normothermic perfusion of rabbit organs. Artificial Organs 2013, 2013 Aug 27. doi: 10.1111/aor.12155.
    • Yap, K.K., Dingle, A.M., Palmer, J.A., Dhillon, R., Lokmic, Z., Penington, A.J., Yeoh, G.C., Morrison, W.A., Mitchell, G.M. Enhanced liver progenitor cell survival and differentiation in vivo by spheroid implantation in a vascularized tissue engineering chamber. Biomaterials, 2013; 34(16):3992-4001 .
    • Hsiao ST, Lokmic Z, Peshavariya H, Abberton KM, Dusting GJ, Lim SY, Dilley RJ. Hypoxic conditioning enhances the angiogenic paracrine activity of human adipose-derived stem cells. Stem Cells Dev. 2013, 2013 May 15;22 (10):1614-23.
    • Lim, S.Y., Hsiao, S.T., Lokmic, Z., Sivakumaran, P., Dusting, D.J., Dilley, R.J., Ischaemic preconditioning promotes intrinsic vascularisation and enhances survival of implanted cells in an in vivo tissue engineering model. Tissue Eng Part A, 2012;18  (21-22):2210-2219.
    • Lokmic, Z., Musyoka, J., Hewitson, T.D., Darby, I.A. Hypoxia and hypoxia signalling in tissue repair and fibrosis. International Review of Cell and Molecular Biology 2012;296: 139-185.
    • Hsiao, S.T., Asgari, A., Lokmic, Z., Sinclair, R., Dusting, G.J., Dilley, R. J. Comparative analysis of paracrine factor expression in human adult mesenchymal stem cells derived from bone marrow, adipose tissue and dermal tissue. Stem Cells Dev 2012; 21(12):2189-2203.
    • Lokmic, Z and Mitchell GM. Visualisation and stereological assessment of blood and lymphatic vessels. Histol Histopathol. 2011 Jun;26 (6):781-96.


    We have been fortunate to receive funding from the Jigsaw Foundation, The Baker Foundation, The Royal Children’s Hospital Foundation, The Ian Potter Foundation and the National Health and Medical Research Council.

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