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Early Surgical Intervention for Proliferating Hemangiomas of the Scalp: Indications and Outcomes

Spector, Jason A. M.D.; Blei, Francine M.D.; Zide, Barry M. D.M.D., M.D.

Plastic and Reconstructive Surgery: August 2008 - Volume 122 - Issue 2 - p 457-462
doi: 10.1097/PRS.0b013e31817d5fa2
Reconstructive: Head and Neck: Original Article

Background: Large hemangiomas of the scalp, though uncommon, present unique challenges to the reconstructive surgeon. If not treated early, these lesions can result in large areas of alopecia, distortion of the hairline, or deformation of the ear. Given these potential complications and the relative pliability and redundancy of the infant scalp before 4 months of age, the authors propose early surgical excision.

Methods: A retrospective review of the senior author’s (B.M.Z.) patient records was performed; over a period of 4 years, six infants were identified who underwent resection of a large scalp hemangioma. The surgical planning and execution of each case and follow-up are detailed.

Results: All six hemangiomas were excised completely. In five cases, the excisions were performed in one stage at or before 4 months of age. In a sixth case, a tissue expander was placed before excision and closure in an 18-month-old infant. In three cases, significant ear malposition was corrected by removal of the deforming mass. There were no complications.

Conclusions: The authors have demonstrated that by taking advantage of the greater elasticity of the infant scalp, large hemangiomas of the scalp can be aggressively and successfully treated with surgical intervention, often in one operation. Beyond the usual indications, early surgical excision of scalp hemangiomas may be advantageous and warranted to prevent the development of large alopecic areas or the permanent distortion of the hairline and aural anatomy.

New York, N.Y.

From the Division of Plastic Surgery, Weill Cornell Medical College, the Department of Pediatrics, and the Institute of Reconstructive Plastic Surgery, Division of Plastic Surgery, New York University School of Medicine.

Received for publication January 17, 2007; accepted December 3, 2007.

Disclosure: The authors have no financial interests to disclose.

Barry M. Zide, D.M.D., M.D., 420 East 55th Street, Suite 1D, New York, N.Y. 10022,

©2008American Society of Plastic Surgeons