Resection of Hemangiomas with Pursestring Closure: A Follow-up Study
June K. Wu, MD, Christine Rohde, MD.
Columbia University, New York, NY, USA.
Background: Hemangiomas often leave contour deformities and scarring after involution. Surgical resection leaves permanent scars and may distort adjacent anatomy. Circular excision with pursetring closure results in the smallest possible scar and minimal distortion.
Methods: 23 patients with varying stages of hemangiomas underwent resection with pursestring closure. The dimensions of each hemangioma was measured at the time of excision. Dimensions of the scar at follow up office visits were recorded. The final scar was calculated as a percentage of the original size of the lesion.
Results: Twenty-three patients underwent circular excision and pursestring closure of 24 hemangiomas. Nineteen (82.6%) were girls and 4 (17.4%) were boys. The ages of the patient ranged from 5 months to 10.5 years, with a median age of 2. One hemangioma was in the proliferating phase, 16 were stabilized or involuting, and 6 were involuted lesions. The locations were: scalp 2(8%), forehead and eyebrow 10(42%); cheek 6(25%), chin and neck 4(16%), and trunk 2(8%). The median area of the hemangiomas was 811mm2 (range: 144 mm2 to 3600mm2). Follow up measurements were available for 13 patients with 14 hemangiomas. Follow up ranged from 6 weeks to 12 months (Median follow up, 4 months). The median area of the pursestring scar was 116mm2 (range: 32mm2 to 900mm2). This change in size was statistically significant (Student’s 2 tailed t test; p=0.0045). The median percentage reduction in area of involvement was 76% (range 24% to 96%). There were 2 complications: 1 patient scratched her incision (76% of original size), and another toddler scraped her scalp against the carpet and dehisced the pursestring closure (36% of original size).
Conclusions: Traditional lenticular excision of hemangiomas results in increased scar length as compared to the original lesion. Circular excision and pursestring closure of defects results in a scar smaller than the original lesion. It is well tolerated and should be considered the default method unless otherwise indicated.