Hemangioma surgery: Difference between revisions

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{{Hemangioma}}
{{Hemangioma}}
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==Overview==
==Overview==
Surgery is not the first-line treatment option for patients with hemangioma. It is usually reserved for patients with either massive protuberant proliferating hemangioma and lesions that are refractory to less invasive treatments.
==Surgery==
==Surgery==
In cases of failed medical therapy, surgical removal often becomes necessary.  
* Surgical management involves excision, laser treatment or both. <ref name="CallahanYoon2012">{{cite journal|last1=Callahan|first1=Alison B.|last2=Yoon|first2=Michael K.|title=Infantile hemangiomas: A review|journal=Saudi Journal of Ophthalmology|volume=26|issue=3|year=2012|pages=283–291|issn=13194534|doi=10.1016/j.sjopt.2012.05.004}}</ref><ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref>
====Tracheostomy====
* Intralesional steroid treatment is also an option for focal hemangiomas such as:
Blockage of the airway will often require a [[Tracheotomy|tracheostomy]] to be performed (insertion of an external airway through the front of the neck into the trachea below the level of the obstruction).
** Parotid
====Pulsed dye laser====
** Nasal tip
Sometimes pulsed dye laser can be used to accelerate healing of ulceration. [[Pulsed dye laser]] can be useful for very early flat lesions if they appear in cosmetically significant areas or for those lesions that leave residual surface blood vessels in the case of incomplete resolution.
** Subglottis
 
** Eyelid
* Repeat therapy is often required, but systemic side effects are limited.
* Excision is the appropriate for localized lesions the fibrofatty remnants (residuum) of involuted hemangiomas.
* Elective subtotal excision of massive protuberant proliferating hemangiomas can be employed in order to maintain aesthetic facial boundaries.
* Small remnants of disease are then left for involution.
===Excision===
* Excision is the appropriate for localized lesions the fibrofatty remnants (residuum) of involuted hemangiomas.
* Elective subtotal excision of massive protuberant proliferating hemangiomas can be employed in order to maintain aesthetic facial boundaries.
* Small remnants of disease are then left for involution.
==Phototherapy==
===Pulsed dye laser===
Pulsed dye laser is considered to be effective choice for a series of skin disorders including superficial hemangiomas.<ref name="CaucanasPaquet2011">{{cite journal|last1=Caucanas|first1=Marie|last2=Paquet|first2=Philippe|last3=Henry|first3=Frédérique|last4=Piérard-Franchimont|first4=Claudine|last5=Reginster|first5=Marie-Annick|last6=Piérard|first6=Gérald E.|title=Intense Pulsed-Light Therapy for Proliferative Haemangiomas of Infancy|journal=Case Reports in Dermatological Medicine|volume=2011|year=2011|pages=1–5|issn=2090-6463|doi=10.1155/2011/253607}}</ref>
* Residual erythema and telangiectasias frequently remain in involuted hemangiomas and are best treated by selective photothermolysis using the flash pulse dye laser (FPDL).
* Ulcerative lesions during proliferation can be treated with FPDL to induce healing and new epidermal growth.
===Intense pulsed light===
* IPL flash lamps emit broadband polychromatic high-intensity light in the wavelength spectrum ranging 515-1200nm.<ref name="CaucanasPaquet2011">{{cite journal|last1=Caucanas|first1=Marie|last2=Paquet|first2=Philippe|last3=Henry|first3=Frédérique|last4=Piérard-Franchimont|first4=Claudine|last5=Reginster|first5=Marie-Annick|last6=Piérard|first6=Gérald E.|title=Intense Pulsed-Light Therapy for Proliferative Haemangiomas of Infancy|journal=Case Reports in Dermatological Medicine|volume=2011|year=2011|pages=1–5|issn=2090-6463|doi=10.1155/2011/253607}}</ref>
* They target vessels at various depths inside the skin.
* The effect relies on selective photothermolysis.
* The indication spectrum includes vascular tumors including hemangiomas.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Cardiology]]
[[Category:Needs overview]]
[[Category:Needs overview]]
[[Category:Primary care]]
[[Category:Up-To-Date]]
 
[[Category:Oncology]]
{{WH}}
[[Category:Medicine]]
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[[Category:Vascular medicine]]
[[Category:Surgery]]

Latest revision as of 22:01, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

Surgery is not the first-line treatment option for patients with hemangioma. It is usually reserved for patients with either massive protuberant proliferating hemangioma and lesions that are refractory to less invasive treatments.

Surgery

  • Surgical management involves excision, laser treatment or both. [1][2]
  • Intralesional steroid treatment is also an option for focal hemangiomas such as:
    • Parotid
    • Nasal tip
    • Subglottis
    • Eyelid
  • Repeat therapy is often required, but systemic side effects are limited.
  • Excision is the appropriate for localized lesions the fibrofatty remnants (residuum) of involuted hemangiomas.
  • Elective subtotal excision of massive protuberant proliferating hemangiomas can be employed in order to maintain aesthetic facial boundaries.
  • Small remnants of disease are then left for involution.

Excision

  • Excision is the appropriate for localized lesions the fibrofatty remnants (residuum) of involuted hemangiomas.
  • Elective subtotal excision of massive protuberant proliferating hemangiomas can be employed in order to maintain aesthetic facial boundaries.
  • Small remnants of disease are then left for involution.

Phototherapy

Pulsed dye laser

Pulsed dye laser is considered to be effective choice for a series of skin disorders including superficial hemangiomas.[3]

  • Residual erythema and telangiectasias frequently remain in involuted hemangiomas and are best treated by selective photothermolysis using the flash pulse dye laser (FPDL).
  • Ulcerative lesions during proliferation can be treated with FPDL to induce healing and new epidermal growth.

Intense pulsed light

  • IPL flash lamps emit broadband polychromatic high-intensity light in the wavelength spectrum ranging 515-1200nm.[3]
  • They target vessels at various depths inside the skin.
  • The effect relies on selective photothermolysis.
  • The indication spectrum includes vascular tumors including hemangiomas.

References

  1. ↑ Callahan, Alison B.; Yoon, Michael K. (2012). "Infantile hemangiomas: A review". Saudi Journal of Ophthalmology. 26 (3): 283–291. doi:10.1016/j.sjopt.2012.05.004. ISSN 1319-4534.
  2. ↑ Richter, Gresham T.; Friedman, Adva B. (2012). "Hemangiomas and Vascular Malformations: Current Theory and Management". International Journal of Pediatrics. 2012: 1–10. doi:10.1155/2012/645678. ISSN 1687-9740.
  3. ↑ 3.0 3.1 Caucanas, Marie; Paquet, Philippe; Henry, Frédérique; Piérard-Franchimont, Claudine; Reginster, Marie-Annick; Piérard, Gérald E. (2011). "Intense Pulsed-Light Therapy for Proliferative Haemangiomas of Infancy". Case Reports in Dermatological Medicine. 2011: 1–5. doi:10.1155/2011/253607. ISSN 2090-6463.

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