О хирургическом иссечении гемангиом
Surgical excision of involuted hemangiomas is not uncommon because of the cutaneous defects resulting from them. Atrophic and hypertrophic scars, as well as anetodermic and tumoral fibro-fatty 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 fibro-fatty tissue, complete removal of all tissue is unnecessary, while removing too much tissue could detract from proper contours.
Surgical excision of proliferating hemangiomas is quite 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 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 employ a relatively avascular tissue plane surrounding actively growing hemangiomas. New advancements in surgical instruments that cauterize while cutting lessen the risk of hemorrhage.
Richard J Antaya, MD, Director of Pediatric Dermatology, Associate Professor, Departments of Dermatology and Pediatrics, Yale University
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Показания к лечению гемангиом
Treatment Indications for Hemangiomas
Threat to life or function
Kasabach-Merritt syndrome (coagulopathy)
Anatomic site
Vision impairment
Respiratory impairment
High-output cardiac failure (mortality up to 50 percent)11
Hepatic lesions
Other internal lesions
Location in scar-prone area
Nose
Lip
Ear
Glabellar area
Any large facial hemangiomas
Pedunculated lesions
FERN A. WIRTH, M.D., and MARK H. LOWITT, M.D. University of Maryland School of Medicine, Baltimore, Maryland
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