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Surgical Treatment of Facial Infantile Hemangiomas: An Analysis Based on Tumor Characteristics and Outcomes

Goldenberg, Dov C. M.D., Ph.D.; Hiraki, Patricia Y. M.D.; Marques, Tatiana Moura M.D., M.Sc.; Koga, Andrea M.D.; Gemperli, Rolf M.D., Ph.D.

Plastic and Reconstructive Surgery: April 2016 - Volume 137 - Issue 4 - p 1221–1231
doi: 10.1097/PRS.0000000000002016
Pediatric/Craniofacial: Original Articles
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Background: Surgical treatment of infantile hemangiomas may interfere with patient appearance. The use of an algorithm is essential to select candidates. The objective of this study was to evaluate outcomes of surgical treatment based on tumor characteristics.

Methods: Seventy-four patients were treated surgically between 1997 and 2010. Demographics, tumor characteristics, surgical approach, and outcomes were evaluated.

Results: The female-to-male ratio was 5.7:1. Mean age and follow-up were 24 years and 33 months, respectively. Surgery was elective in 83.8 percent and emergent in 16.2 percent of patients. Most frequent locations were lips, nose, eyelids, and cheeks. Surgery was performed during the proliferative phase in 43 patients (58.1 percent), and growth-related deformity was the main indication. No significant association between sex and the presence of complications or treatment indication was observed. Patients who underwent emergency procedures were younger (p = 0.0031) and had a higher incidence of evolutional complications (p = 0.012). Also, they were more frequently operated on during the proliferative phase (p = 0.011). Favorable outcome of surgical treatment was observed in both simple and complex cases for facial contour, volume reduction, and need for reoperation. The best candidates for elective surgery were patients with localized eyelid, nasal, or lip hemangiomas, presenting growth-related deformities during the proliferative phase. For patients undergoing emergency procedures, the best candidates were nonresponders to pharmacologic therapy with segmental periorbital hemangiomas, treated by partial resection.

Conclusions: A profile of patients and their specific surgical approach was established. Satisfactory results could be achieved following the proposed algorithm.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

This and Related “Classic” Articles Appear on Prsjournal.Com for Journal Club Discussions.

Sao Paulo, Brazil

From the Divisions of Plastic Surgery and General Surgery, Hospital das Clinicas, University of Sao Paulo Medical School.

Received for publication May 18, 2015; accepted November 20, 2015.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Dov C. Goldenberg, M.D., Ph.D., Rua Arminda 93 cj. 121, Sao Paulo, Brazil 04545-100, drdov@me.com

©2016American Society of Plastic Surgeons