Resection and modified purse-string closure of frontal hemangioma

Infantile hemangiomas occurring in the face may represent a real problem to a child. Clinical significance is ultimately determined by the degree of tissue deformation. Large dimensions; specific locations; and the presence of complications such as ulceration, bleeding, or infection indicate active treatment to minimize morbidity. The combination of clinical features and response to pharmacologic treatment are the main standpoints indicating surgery during the active phases of infantile hemangiomas.
The concept of minimal possible scar is relevant, and the use of purse-string sutures, initially proposed by Mulliken et al., promotes a real reduction in the final scar dimensions. In this video surgical resection of a frontal hemangioma illustrates a modified purse string suture, to reduce the dimensions of a linear scar.
Dov Charles Goldenberg, MD Phd, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School
Vania Kharmandayan, MD, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School

Resection and modified purse-string closure of frontal hemangioma
Frontal proliferative hemangioma causing deformity Infantile hemangioma with evolutive complications Infantile hemangioma non responder to pharmacological therapy
Medical conditions Parental concerns
General anesthesia through oral intubation. Marking of hemangioma limits Design planned lenticular excision Infiltration with local anesthetics and vasoconstrictor Prep area with betadine Eye protection Demarcation of the limits of the tumor
Parental detailled explanation of the procedure and post-operative evolution General lab preo-op test including Hemoglobin, red blood clount and coagulation tests
Marking of hemangioma limits and lenticullar possible excision Incision around the limit of the hemangioma (round excision) Uniform undermining in subcutaneous plane
Suture dehiscences Scars widening needing revision
Fernando Rosas Brito for video and image editing
Goldenberg DC, Hiraki PY, Marques TM, Koga A, Gemperli R. Surgical Treatment of Facial Infantile Hemangiomas: An Analysis Based on Tumor Characteristics and Outcomes. Plast Reconstr Surg. 2016 Apr;137(4):1221-31. doi: 10.1097/PRS.0000000000002016. Dégardin-Capon N, Martinot-Duquennoy V, Patenotre P, Brevière GM, Piette F, Pellerin P. Early surgical treatment of cutaneous hemangiomas (in French). Ann Chir Plast Esthet. 2006;51:321–329 Mulliken JB, Rogers GF, Marler JJ. Circular excision of hemangioma and purse-string closure: The smallest possible scar. Plast Reconstr Surg. 2002;109:1544–1554; discussion 1555

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