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Plastic Surgery | Reconstructive Surgery

PROCEDURE : SURGICAL

What are hemangiomas?
Hemangiomas are:
  • The most common vascular tumors in infants, characterized by rapidly dividing endothelial cells.
  • Typically appear as well-demarcated, flat, and erythematous red patches shortly after birth.
  • Classified into two types: infantile hemangiomas and congenital hemangiomas.
How do hemangiomas develop?
Hemangiomas develop due to:
  • Hyperplasia of endothelial cells.
  • Potential genetic factors and abnormalities in placental tissue embedded in fetal soft tissues during gestation.
  • High levels of proangiogenic factors like VEGF, b-FGF, and TGF-beta 1.
What are the phases of hemangioma development?
Hemangioma development consists of three phases:
  • Proliferation Phase: Rapid growth, especially within the first 6 months of life.
  • Quiescence Phase: A period of little to no growth, usually occurring from 9 to 12 months of age.
  • Involution Phase: Gradual shrinking and fading of the hemangioma, often leaving behind a fibrofatty residue.
Before
After
How are hemangiomas diagnosed?
Hemangiomas are diagnosed by:
  • Clinical history and physical examination.
  • Imaging tests like Doppler ultrasound or MRI for uncertain cases.
What treatment options are available for hemangiomas?
Treatment options for hemangiomas include:
  • Observation: For inconspicuous lesions.
  • Medical Management: Corticosteroids, propranolol, and other systemic therapies for problematic hemangiomas.
  • Surgical Management: Excision or laser treatment for persistent or disfiguring hemangiomas.
What is the role of propranolol in treating hemangiomas?
Propranolol is used for:
  • Causing regression of proliferating hemangiomas.
  • Administered in doses of 2-3 mg/kg, showing significant reduction in hemangioma size within 1-2 weeks.
  • Monitoring and regular follow-ups are essential due to potential side effects like hypoglycemia.
Dr. Aakansha
What are vascular malformations?
Vascular malformations are:
  • Congenital anomalies of blood vessels, present at birth but may become noticeable later.
  • Classified into types like venous malformations, arteriovenous malformations (AVMs), and lymphatic malformations.
  • Slow-flow (venous, lymphatic) or fast-flow (AVMs) based on blood flow through the affected vessels.
How are lymphatic malformations diagnosed?
Lymphatic malformations are diagnosed by:
  • Clinical examination, identifying soft, fluid-filled swellings, often present at birth or by 2 years of age.
  • MRI used for confirming diagnosis and determining the extent of disease.
What treatment options exist for lymphatic malformations?
Treatment for lymphatic malformations includes:
  • Sclerotherapy: Injection of sclerosing agents to induce fibrosis.
  • Surgery: For macro cystic lesions, or when other methods are not effective.
  • Laser Therapy: Used for limited disease, especially in airway or oral mucosa.
What are capillary malformations and how are they treated?
Capillary malformations (CMs) are:
  • Sporadic lesions consisting of dilated capillary-like channels, often referred to as port-wine stains.
  • Treated primarily with laser therapy, such as Flash lamp-pumped Pulsed Dye Laser (FPDL), to fade the redness over multiple sessions.
What complications can arise from venous malformations?
Complications of venous malformations include:
  • Pain and swelling: Due to venous congestion and thrombosis.
  • Airway obstruction: Particularly when they occur in the head and neck regions.
  • Recurrence after treatment: Especially when not completely excised.
How are arteriovenous malformations (AVMs) managed?
Management of AVMs involves:
  • Embolization: Blocking abnormal blood vessels to reduce blood flow and prepare for surgery.
  • Surgical Excision: Removal of AVM tissue, often following embolization to minimize bleeding.
  • Regular monitoring: Due to the high risk of recurrence and potential life-threatening complications.

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