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Goel A, Goel A. Optimal timing for plastic surgical procedures for common congenital anomalies: A review. World J Clin Pediatr 2024; 13:90583. [DOI: 10.5409/wjcp.v13.i2.90583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 06/07/2024] Open
Abstract
Apart from listening to the cry of a healthy newborn, it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents. The global incidence of children born with congenital anomalies has been reported to be 3%-6% with more than 90% of these occurring in low- and middle-income group countries. The exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several reasons. These children are operated under several surgical disciplines, viz, paediatric-, plastic reconstructive, neuro-, cardiothoracic-, orthopaedic surgery etc. These conditions may be life-threatening, e.g., trachea-oesophageal fistula, critical pulmonary stenosis, etc. and require immediate surgical intervention. Some, e.g., hydrocephalus, may need intervention as soon as the patient is fit for surgery. Some, e.g., patent ductus arteriosus need ‘wait and watch’ policy up to a certain age in the hope of spontaneous recovery. Another extremely important category is that of patients where the operative intervention is done based on their age. Almost all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery (many as multiple stages of correction) at appropriate ages. There are advantages and disadvantages of intervention at different ages. In this article, we present a review of optimal timings, along with reasoning, for surgery of many of the common congenital anomalies which are treated by plastic surgeons. Obstetricians, paediatricians and general practitioners/family physicians, who most often are the first ones to come across such children, must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.
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Affiliation(s)
| | - Arun Goel
- Department of Plastic Surgery, Lok Nayak Hospital and Associated Maulana Azad Medical College, New Delhi 110002, India
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DiDonna N, Khan K, Wood J. Infantile Scalp Hemangiomas: Surgical Management and Lessons Learned. J Craniofac Surg 2023:00001665-990000000-01191. [PMID: 37955432 DOI: 10.1097/scs.0000000000009816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/26/2023] [Indexed: 11/14/2023] Open
Abstract
Infantile hemangiomas (IH) are common benign vascular tumors in pediatric patients, often found on the scalp. While most IH naturally regress without intervention, surgical excision becomes necessary when severe anatomic or physiological complications arise. This review examines previously published case studies on pediatric scalp IH excisions, focusing on surgical outcomes and complications. A comprehensive search of the US National Library of Medicine National Institutes of Health (PubMed) database identified 19 relevant case studies. Most patients were female, with a wide age range at the time of excision. Various anatomic locations and sizes of the hemangiomas were observed. The reviewed literature demonstrates that surgical excision of scalp IH can be performed with minimal complications, even for sizable tumors. Successful outcomes and low complication rates highlight the effectiveness of surgical intervention in cases of life-threatening IH sequelae. Further research is warranted to explore optimal timing, techniques, and adjunct therapies for surgical management of scalp IH.
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Affiliation(s)
- Nicole DiDonna
- University of North Carolina School of Medicine, University of North Carolina
| | - Kamran Khan
- Division of Plastic & Reconstructive Surgery, University of North Carolina, Chapel Hill, NC
| | - Jeyhan Wood
- Division of Plastic & Reconstructive Surgery, University of North Carolina, Chapel Hill, NC
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Bleve C, Conighi ML, Valerio E, Cutrone M, Iannucci G, Segna A, Chiarenza SF. Surgical management of large scalp infantile hemangioma in 30-month-old infant. LA PEDIATRIA MEDICA E CHIRURGICA 2022; 44. [DOI: 10.4081/pmc.2022.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Infantile Hemangiomas (IH) are the most common benign tumor of infancy, occurring in over 10% of newborns. The head and neck is the most frequently affected area (60%), and the scalp is a typical site for such large lesions. Scalp-IHs are usually focal lesions that can be both disfiguring and may lead to complications such as ulceration and bleeding. We describe a case of a 30-months old female who presented a large scalp-IH at birth that rapidly grew in the first year of life. Topical and systemic treatments (with timolol ointment and oral propranolol, respectively) were not effective in reducing dimensions of the hemangioma. After vascular imaging study, the patient underwent surgical resection of the IH and primary closure with excellent cosmetic outcome. When medical therapy is ineffective or cosmetic and functional integrity is threatened, early surgery allows to completely removing large scalp-IHs, with good cosmetic results.
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Wu Y, Qiu R, Zeng L, Liang L, Zhang J, Zhou J, Jiang W, Su J, Deng X. Effective surgical treatment of life-threatening huge vascular anomalies associated with thrombocytopenia and coagulopathy in infants unresponsive to drug therapy. BMC Pediatr 2020; 20:187. [PMID: 32340603 PMCID: PMC7187498 DOI: 10.1186/s12887-020-02093-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 04/20/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Systemic drug therapy is generally recommended for infant huge vascular anomalies associated with thrombocytopenia and coagulopathy, but some patients are not suitable due to drug unresponsiveness or life threatening conditions before the drug works, who will need to receive surgical treatment. This study retrospectively analyzed the clinical features, imaging features, and surgical outcomes of these patients. METHODS The clinical data of 4 infants with huge vascular anomalies (2 vein malformations (VMs) and 2 kaposiform hemangioendothelioma (KHE)) associated with thrombocytopenia and coagulopathy treated from June 2016 to December 2017 were retrospectively analyzed. All patients received glucocorticoids, propranolol, vincristine or sirolimus treatment before admission, but the treatment was ineffective. Skin petechia, thrombocytopenia and coagulopathy were present at the time of admission. CT scanning was performed before operation. The patient's general clinical data, hematological examination results, operation time, surgical bleeding volume, blood transfusion volume and surgical complications were collected for analysis. The patients were followed up for 10-26 months. RESULTS CT scanning results of 2 patients showed special CT features without detectable enhancement within the lesion after CT enhanced scanning and multiple phleboliths formation. Four patients underwent surgical treatment successfully. Two patients underwent complete resection of the lesion, and 2 underwent cytoreductive surgery. Preoperative clinical symptoms such as skin petechia, thrombocytopenia and coagulopathy were normal at 1 week after surgery. Postoperative pathological results showed 2 cases of KHE and 2 cases of VMs. All patients were discharged from hospital without physical dysfunction, recurrence, or death. CONCLUSIONS Timely and appropriate surgical intervention can achieve satisfactory results for infants with huge VMs and KHE who were unresponsive to drug therapy or suffering from life-threatening occasion before the drug become effective.
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Affiliation(s)
- Yaohao Wu
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Ronglin Qiu
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Lexiang Zeng
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Liyang Liang
- Department of Pediatric, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jie Zhang
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Jiajia Zhou
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Wenli Jiang
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Jianhang Su
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Xiaogeng Deng
- Department of Pediatric Surgery, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.
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Chang S, Yu W, Gu Y, Han Y, Shang Y, Chang L, Jin Y, Ma G, Qiu Y, Lin X. Location of infantile hemangioma is a predictor of volumetric sequelae after involution. J Dermatol 2019; 46:371-375. [PMID: 30888067 DOI: 10.1111/1346-8138.14847] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Shih‐Jen Chang
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Wenxin Yu
- Department of Laser and Aesthetic Medicine Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yifei Gu
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yue Han
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Ying Shang
- Department of Laser and Aesthetic Medicine Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Lei Chang
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yunbo Jin
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Gang Ma
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yajing Qiu
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Department of Laser and Aesthetic Medicine Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
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Karimi H, Latifi NA, Momeni M, Sedigh-Maroufi S, Karimi AM, Akhoondinasab MR. Tissue expanders; review of indications, results and outcome during 15 years' experience. Burns 2019; 45:990-1004. [PMID: 30685190 DOI: 10.1016/j.burns.2018.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/20/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Tissue expanders (TE) are frequently used worldwide. In this study we surveyed outcome of our patients retrospectively during 15 years. MATERIALS AND METHODS We had 1105 patients for whom 3059 TEs have been used. Demographic data, age, sex, indications, type of tissue expander devices, volume of devices, site of scar and site TE insertion, our technique for tissue expander insertion and flap design, complications and outcome were gathered. A complete and through technical points and tips will be discussed. RESULTS In 91% of patients overexpansion was done. (Expansion ratio=2.1-4.5). Re-expansion has been done in about 12% of patients. Complications were perforation of skin of pocket (11%) or exposure, infection (6%), dehiscence of the wound (1.5%), perforation of the port or disconnection of the tubes (2.1%), expansion of the scar itself (1%), saggy flap (3%), dog ear (5%), lack of adhesions of flap to its new site (4%). OUTCOME In 93% of the patients we could totally remove the scar. Around 9.1% of our patients had two sessions of expansion in the same area and 2.9% had three sessions of expansion. 51% of our patients were highly satisfied and 42% were satisfied of the results of expansion. CONCLUSION Our patients were satisfied with the results. In 12% cases we have done re-expansion. Re-expansion is possible as long as you have enough thickness of dermis in the skin. More than 50% of our patients were optimistic for 2nd or 3rd session of re-expansion.
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Affiliation(s)
- Hamid Karimi
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Noor-Ahmad Latifi
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnoush Momeni
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Ryu HS, Moon KS, Lee KH, Kim IY, Jung S. Dural Penetration of Cavernous Hemangioma on Skull: Uncommon Clinical Presentation. World Neurosurg 2017; 110:39-42. [PMID: 29109062 DOI: 10.1016/j.wneu.2017.10.148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cavernous hemangioma (CH) of the bone is a rare, benign neoplasm found usually in the vertebral body. This tumor rarely develops in the calvaria, with predilection to occur in the frontal and temporoparietal bones. CASE DESCRIPTION A 56-year-old man with a right frontal palpable mass was admitted to our hospital. Magnetic resonance imaging (MRI) revealed a large extra-axial tumor in the right frontal bone. Intraoperatively, the bony mass involved the multilayers composed of extracranium-skull-dura-intradura-cortex. Pathologic examination revealed a typical calvarial CH penetrating dura mater. CONCLUSIONS This is the second reported case of calvarial CH with complete erosion of the dural plane and extension into subdural space. Although surgical resection is generally safe and easy, the possibility of dural invasion should be kept in mind for safe resection of calvarial CH, especially overlying the eloquent brain area.
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Affiliation(s)
- Hyun-Seung Ryu
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea
| | - Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea.
| | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea
| | - In-Young Kim
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea
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Statistical Analysis of Influences on the Psychosocial Status of Children With Hemangiomas and Their Families. J Craniofac Surg 2017; 28:2056-2059. [PMID: 28938335 DOI: 10.1097/scs.0000000000003982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The psychologic stress on the child and family, which arise from hemangiomas, the most common neoplasm of childhood, cannot be overestimated. This study determined the preoperative and postoperative psychosocial status and variation among Oriental children with hemangiomas and their families by questionnaire. Thirty patients who underwent surgery for hemangiomas were assessed for preoperative and postoperative psychosocial status by questionnaire. The distribution of the total mean score and variation between the preoperative and postoperative status was estimated. Based on these results, the significance was statistically analyzed according to variable determinants. This study showed that hemangiomas have harmful effects on psychosocial status of patients and families. After corrective surgery, an improvement in psychosocial status was noted with respect to the self-esteem category or categories related to social activity, and in the following variables, women, face, and dissatisfaction with appearance. When the authors care for patients with hemangiomas and their families, the psychosocial health must be presumed to be at particular risk. Earlier surgical interventions with esthetic concerns have permitted the patient and family the opportunity to reduce the psychologic impact that the hemangioma may otherwise have.
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Zhu Z, Yang X, Zhao Y, Fan H, Yu M, Topaz M. Early Surgical Management of Large Scalp Infantile Hemangioma Using the TopClosure® Tension-Relief System. Medicine (Baltimore) 2015; 94:e2128. [PMID: 26632734 PMCID: PMC5059003 DOI: 10.1097/md.0000000000002128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Infantile hemangiomas (IHs) are the most common benign vascular neoplasms of infancy and childhood. The majority do not need medical intervention. However, large ulcerated scalp IHs may lead to fatal bleeding as well as severe cosmetic disfigurement that indicate early surgical excision, inflicting substantial surgical risks, with short- and long-term morbidity.The TopClosure Tension-Relief System (TRS) is an innovative skin stretching and wound closure-secure system that facilitates primary closure of relatively large skin defects. This system has been shown as a substitute for skin grafts, flaps, or tissue expanders.We describe a case of a giant IH of the scalp usually requiring a complex surgical approach, which was immediately primarily closed applying the TRS.A 3-day-old female infant presented with a giant scalp hemangioma at birth that rapidly grew in the neonatal period with early signs of ulceration. The patient underwent surgical resection of the giant scalp hemangioma with immediate primary closure of the defect using the TRS. Surgical procedure and postoperative period were uneventful.Early surgical resections of IHs at infancy carry substantial surgical risks and morbidity. This is the first reported case of early resection of a scalp hemangioma in the neonatal period, with successful immediate primary closure by application of stress-relaxation technique through the TRS. The application of the TopClosure TRS in this age group has significant advantages. It reduces the complexity and length of surgery, reducing blood loss, eliminating donor site morbidity, improving wound aesthetics, and minimizing the need for future reconstructive procedures.
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Affiliation(s)
- Zhanyong Zhu
- From the Department of Plastic Surgery (ZZ, YZ, HF, MY); Department of Otorhinolaryngology (XY), Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China; and Plastic Surgery Unit (MT), Hillel Yaffe Medical Center, Hadera, Israel
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Khan IS, Kiehna EN, Satti KF, Ehtesham M, Ghiassi M, Singer RJ. Surgical management of large scalp infantile hemangiomas. Surg Neurol Int 2014; 5:41. [PMID: 24818048 PMCID: PMC4014822 DOI: 10.4103/2152-7806.129560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background: Infantile Hemangiomas (IH) are the most common benign tumor of infancy, occurring in over 10% of newborns. While most IHs involute and never require intervention, some scalp IHs may cause severe cosmetic deformity and threaten tissue integrity that requires surgical excision. Case Description: We present our experience with two infants who presented with large scalp IH. After vascular imaging, the patients underwent surgical resection of the IH and primary wound closure with excellent cosmetic outcome. We detail the surgical management of these cases and review the relevant literature. Conclusion: In some cases the IHs leave behind fibro-fatty residuum causing contour deformity. Surgery is often required for very large lesions causing extensive anatomical and/or functional disruption. The goal of surgical intervention is to restore normal anatomic contour and shape while minimizing the size of the permanent scar.
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Affiliation(s)
- Imad S Khan
- Division of Neurosurgery, Geisel School of Medicine at Dartmouth, Lebanon NH, USA
| | - Erin N Kiehna
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Canada
| | - Komal F Satti
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon NH, USA
| | - Moneeb Ehtesham
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville TN, USA
| | - Mahan Ghiassi
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville TN, USA
| | - Robert J Singer
- Division of Neurosurgery, Geisel School of Medicine at Dartmouth, Lebanon NH, USA
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Silva RDP, da Silva Cavalcante JE, Miranda EQ, Lopes DF, Souto LRM. Giant hemangioma presenting as a scalp mass leading to a craniofacial deformity. J Maxillofac Oral Surg 2014; 12:218-23. [PMID: 24431843 DOI: 10.1007/s12663-011-0218-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 03/22/2011] [Indexed: 02/05/2023] Open
Abstract
Hemangioma is the most common vascular tumor during childhood. However, cases of giant hemangiomas determining deformities in the craniofacial region are not reported frequently. Craniofacial giant hemangiomas are challenging for surgeons since they cause aesthetic and/or functional problems and may be associated with important complications such as ulcerations, infections and bleedings. The present report is aimed at describing a rare case of craniofacial asymmetry in a 30-year-old patient, secondary to an extensive mass whose growth deformed the scalp in the frontal-parietal-temporal region. The lesion was completely surgically removed with good aesthetic results, and the anatomopathological examination revealed that it was a cavernous hemangioma.
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Affiliation(s)
| | - José Edson da Silva Cavalcante
- Department of Neurosurgery, School of Medical Sciences, Universidade Federal de Goiás (UFG), Goiânia, Goiás Brazil ; Service of Residency in Neurosurgery, Hospital Santa Mônica, Aparecida de Goiânia, Goiânia, Goiás Brazil
| | - Eduardo Queiroz Miranda
- Service of Residency in Neurosurgery, Hospital Santa Mônica, Aparecida de Goiânia, Goiânia, Goiás Brazil
| | - Dionísio Figueiredo Lopes
- Service of Residency in Neurosurgery, Hospital Santa Mônica, Aparecida de Goiânia, Goiânia, Goiás Brazil
| | - Luís Ricardo Martinhão Souto
- Division of Plastic Surgery, Department of Surgery, School of Medical Sciences, Universidade de Marília (UNIMAR), Av. Rio Branco, 1132-Cj. 41, CEP 17502-000 Marília, São Paulo Brazil
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Surgical treatment of infantile hemangioma in a multidisciplinary vascular anomalies clinic. Int J Pediatr Otorhinolaryngol 2011; 75:1271-4. [PMID: 21803434 DOI: 10.1016/j.ijporl.2011.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/03/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE (1) Discuss indications for surgical treatment of infantile hemangioma (IH); (2) describe outcomes, management of complications and long term surveillance of surgically treated IH. STUDY DESIGN Retrospective. SUBJECTS AND METHODS The charts of children seen in a dedicated vascular anomalies center at a tertiary pediatric hospital were reviewed. RESULTS Out of 1012 patients diagnosed with IH over 27 months, 92 patients, predominantly caucasian female, with an average age of 36 months, underwent surgery for 94 lesions. Head and neck lesions accounted for 67% of the population and 51 lesions were located on the face. Surgical indications included bleeding, functional impairment, ulceration and cosmetic disfigurement. Mean surface area was 7.75 cm². Although lesions requiring additional procedures were larger (median 5.5 cm²) than single-stage excisions, this difference was not statistically significant (P=0.09). Head and neck lesions were more likely to require multiple modality treatment (P=0.003). There was no identified objective criteria to predict head and neck lesions that are more likely to be associated post-operative complications. CONCLUSIONS Most IH do not require treatment. The majority of infantile hemangioma occurred on the head and neck. When significant functional impairment, ulceration, bleeding, cosmetic deformity is encountered or anticipated, surgical therapy can be performed at any clinical phase with few complications and favorable outcomes.
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Kim LHC, Hogeling M, Wargon O, Jiwane A, Adams S. Propranolol: useful therapeutic agent for the treatment of ulcerated infantile hemangiomas. J Pediatr Surg 2011; 46:759-763. [PMID: 21496551 DOI: 10.1016/j.jpedsurg.2011.01.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 01/07/2011] [Accepted: 01/10/2011] [Indexed: 11/24/2022]
Abstract
Infantile hemangioma (IH) is the most common vascular tumor in early childhood. Ulceration is the most frequent complication, and its management can be challenging. We present 6 cases of ulcerated IH at a single pediatric center, which responded to oral propranolol within 2 to 6 weeks. We recommend that oral propranolol therapy be considered for the management of ulcerated IH as first-line treatment.
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Affiliation(s)
- Lawrence H C Kim
- Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, New South Wales, Australia.
| | - Marcia Hogeling
- Department of Pediatric Dermatology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Orli Wargon
- Department of Pediatric Dermatology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Ashish Jiwane
- Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Susan Adams
- Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Abstract
Hemangioma is the most common tumor of infancy, occurring mostly in the head and neck region. Intervention during the proliferating phase is indicated if the lesion poses a threat to life or function. Posterior head and neck hemangioma causing deformational plagiocephaly is a further indication for intervention.
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McHoney M. Early human development: neonatal tumours: vascular tumours. Early Hum Dev 2010; 86:613-8. [PMID: 20850940 DOI: 10.1016/j.earlhumdev.2010.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 08/26/2010] [Indexed: 11/30/2022]
Abstract
Vascular tumours (haemangiomas and malformations) are common tumours of infancy and childhood. They represent a group of mostly benign conditions, which present early, can grow rapidly and be symptomatic or disfiguring. There are various management options, with different cosmetic and functional outcomes. Haemangiomas and vascular malformations have different clinical courses which dictate respective management; differentiating them is key. Haemangiomas are generally self-limiting after initial proliferation; generally management is conservative. Symptoms can call for treatment. Options include laser, steroids, chemotherapy and surgery. Propanolol, the newest modality of treatment, may have a dramatic effect in problematic lesions. Vascular malformations are a less common group of heterogenous lesions, with some overlap between entities. They do not involute. Treatment options include laser therapy, sclerotherapy, embolisation, and surgery. Emerging therapies include photodynamic therapy and angiogenesis inhibitors. This review will outline the evidence for the various modalities in managing these conditions.
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Affiliation(s)
- Merrill McHoney
- Royal Hospital for Sick Children Edinburgh, Sciennes Road, Edinburgh, EH1 1LF, UK.
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Literature Watch. Lymphat Res Biol 2008. [DOI: 10.1089/lrb.2008.63411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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