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Earlier
the general concept was to wait until the end of the
involution phase and a surgical correction of the
sequela (fibrofatty residuum, excess dyschromic
tissue, sagging). Today, some surgeons recommend an
early surgical intervention particularly in some
cases. On the other hand, a majority of surgeons
reserve this option for cases in which all other
therapies have failed and the hemangioma still
presents a risk to the patient.
Surgery
is, in general, only considered during the
involution phase, but in certain circumstances it
does have a role in the late proliferation phase
(e.g. large lip hemangioma that has not responded to
steroids).
Surgery
in early childhood should be considered in the
following situations:
- If
it is obvious that resection is inevitable
- If
the scar would be the same length or
appearance were excision to be postponed
until late involution or involuted phase
- If
the scar can be easily concealed
- Nasal
hemangioma (“cyrano” hemangioma)
- Lip
hemangioma (involuting/involuted)
- Eyelid
hemangioma impairing the vision
- Large
forehead hemangioma
- Pedunculated
hemangiomas that bleed repeatedly
- To
excise the residual fibrofatty tissue (sequela
of hemangioma) in the late involution phase.
Consideration
should be given to the emerging facial image prior
to school attendance.
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