Surgical Treatment for Sequelae of Infantile Hemangiomas: Its Role Within the Therapeutic Management of These Tumors

Bulea Raluca¹, Enescu DM^1,2, Giuvelea Steluţa², Stoicescu Simona^1,2, Alexandru Raluca², Ioniţă D²

1 Plastic and Reconstructive Surgery Chair, “Grigore Alexandrescu” Emergency Clinical Hospital for Children, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2 Clinic of Plastic Surgery, Reconstructive Microsurgery and Burns, “Grigore Alexandrescu” Emergency Clinical Hospital for Children, Bucharest, Romania

Introduction: Infantile hemangiomas belong to the group of vascular anomalies. They have a unique evolution pattern: at birth they are usually unapparent, then an explosive growth follows (proliferative phase). For the next 5–7 years, the involutive phase develops, marking a slow regression of the tumor. The final stage is the involuted phase, which may present with residual scars or sequelae.
Material and methods: The purpose of the present study is to assess the place and role surgical treatment has within the complex therapeutic management of IHs in the stage of sequelae.
Results: During a period of 30 months, we selected 21 children that met our including criteria; the average follow up was of 9 months. Only three patients received no treatment at all during early childhood. Indications for surgical treatment in the stage of sequelae were alopecia, the presence of bulky masses, unaesthetic facial scars, retractile scars, ectropion, pain and functional impairment on the fingers and foot.
Conclusions: Our study has shown that surgical correction can lead to significant improvement of the patient’s appearance and of the functions affected by the hemangioma’s sequelae. For medium sized sequelae, the lenticular excision is the best way to diminish the residual scar. In the case of large sequelae, seriate excision represents a better approach, using sometimes more specific plastic surgery techniques, like local flaps, Z plasty or tissue expansion.