What is the role of surgical excision in the treatment of infantile hemangiomas?

Updated: Feb 06, 2019
  • Author: Richard J Antaya, MD; Chief Editor: William D James, MD  more...
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Answer

Surgical excision of involuted hemangiomas is not uncommon because of the cutaneous defects resulting from them. [14] Atrophic and hypertrophic scars, as well as anetodermic and tumoral fibrofatty skin, may result in significant cosmetic or functional impairment. The benefits of excision during late involution include a reduced risk of hemorrhage and a potentially smaller lesion because of the natural course. In addition, because involuted hemangiomas are composed primarily of fibrofatty tissue, complete removal of all tissue is unnecessary, while removing too much tissue could detract from proper contours.

Surgical excision of proliferating hemangiomas is potentially hazardous because of the risk of hemorrhage and damage to vital structures associated with them (ie, head, neck); therefore, only specially trained surgeons should perform this procedure. Certain benefits to early excision include saving a life or preserving vision and decreasing the negative psychosocial effects associated with a cosmetically disfiguring lesion during early childhood. Other benefits of early excision include the use of naturally expanded skin to aid in primary closure and the ability to use a relatively avascular tissue plane surrounding actively growing hemangiomas. New advancements in surgical instruments that cauterize while cutting lessen the risk of hemorrhage. Treatment with propranolol has resulted in a significant decrease in the need for surgery in at least one center. [76]


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