infantile hemangiomas | Acta Medica Marisiensis

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.

Surgical treatment of anogenital hemangiomas of infancy

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

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

DOI: 10.2478/amma-2014-0046

Introduction Infantile hemangiomas (IHs) are the most common benign tumors of the soft tissue in infants and children and they often represent a serious challenge for the treating physician. Hemangiomas located in the anogenital region represent only about 1% of all IHs, but raise special concerns as they have the propensity to ulcerate. This condition may appear spontaneously, or could result from therapeutic procedures. Ulceration is extremely painful and takes many weeks of conservative therapy to heal.
Material and Methods. The aim of this study is to present the surgical approach of the IHs located in the anogenital area and the outcomes of this treatment option.
Results. During a period of 36 months, 11 children (nine girls, two boys) were referred to our plastic surgery department with hemangiomas involving the anogenital, groin and perineum areas. The average follow-up period was of 8 months, during which 82% of cases experienced complications, especially ulceration. All the target hemangiomas were removed through a lenticular excision and the wound closed with a linear suture.
Conclusions. Our study has shown that surgical excision of a complicated anogenital hemangioma or of a “healthy” hemangioma at high risk for ulceration in the anogenital region is an effective treatment, with fast healing and complete resolution of the pathogenic condition. Lenticular excision and linear closure represent a convenient surgical technique that can be performed as early surgery, during the proliferative stage, or at any time later, when the patient needs treatment, in safety conditions and with good results.