Hemangioma Excision

Infantile hemangiomas are vascular tumors composed of proliferating endothelial cells. They uniquely undergo rapid expansion from birth to 6-8 months of age and subsequent slow dissolution over several years thereafter. Some hemangiomas are at risk of causing functional problems during their growth phase as seen in this upper eyebrow lesion obstructing the visual axis. Laser, surgical and medical treatment options are available for problematic hemangiomas. This patient was elected to undergo excision to completely remove the lesion and forego a long course of medical therapy (propranolol). Because of the their vascular nature, excision of hemangiomas requires careful planning and hemostasis. The hemangioma is marked in elliptical fashion along natural aesthetic facial lines along the brow. The inferior mark in incised first. Careful subdermal dissection is critical to completely excise to the hemangioma near the surface and find the appropriate plane. Control of bleeding is maintained by monopolar and bipolar electrocautery as well as dissecting the lesion from one side and alternating to the other. The plane of deep dissection is rarely below the subcutaneous layer thus protecting important nerves and vessels. Complete removal is possible. Closure is performed with dissolvable monocryl or PDS suture with dermabond superficially. A plastic eyeshield (blue) is placed at the beginning of case to protect the patient’s cornea during the procedure.

DOI: http://dx.doi.org/10.17797/zlvhux8afu

Cranioplasty and Scar Revision

Contributors: Michael Golinko (MD) and Kumar Patel (PA)

A six-year-old male with history of skull trauma acquired in an ATV accident underwent emergency craniotomy three years ago. He now presents with bone resorption, frontal bossing, scalloped bone, and a widened scar in the middle of his forehead from the previous surgery.

DOI#:https://doi.org/10.17797/bysho32ez5

Dorsal bridge plating for distal radius factures

Contributors:Katherine Faust and Jacob Brubacher

Internal distraction, or bridge plating, of distal radius fractures is a valuable tool for highly comminuted and unstable fracture patterns. Additionally, this technique is valuable for those fractures that extend into the metadiaphysis or for multiply injured patients requiring stable fixation for mobilization. Bridge plating allows for stable fixation in poor bone quality and early use of the injured extremity.

Posterior Cranial Vault Remodeling for Shunt-Induced Crainiocerebral Disporpotion (CCD)

Contributors: Kumar Patel, PA-C and Gregory W. Albert

Posterior cranial vault remodeling post shunt induced Crainiocerebral Disporpotion (CCD)  Patient is a 5 y/o boy having frequent headaches which may be indicative of increased intra-cranial pressure in addition to a step-off deformity of his posterior calvarium.

DOI#: http://dx.doi.org/10.17797/d03zxkvg2h

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