Surgery of Hemangiomas

Surgical management of infantile hemangiomas (Hm) usually consists of late correction of contour deformities after completed spontaneous involution with excision of remaining fibrofatty tissue and exuberant skin. The range of indications to early surgical excision of Hm during the proliferating phase or after partial involution has been recently enlarged with the introduction of particular techniques adopted in order to minimize intra-operative bleeding and optimize scarring. On the basis of our experience, early surgical excision can be considered in the following situations: rapidly growing Hm with expectance of relevant fibrofatty remnants after involution; voluminous tuberous Hm anatomically located in barely exposed areas where scars are easily concealed; pedunculated Hm with a narrow implantation base; non involutive congenital Hm (NICH type); palpebral Hm with secondary functional impairment of palpebral motility not responding to corticosteroids and/or laser treatment; ulcerated and bleeding Hm not responding to corticosteroids and/or laser treatment; and Hm of the nose producing secondary cartilage deformity.