Managing Hemangiomas in Young Children: Surgical Options and Care

Hemangiomas in children

Hello Dr.
Zhou,
I would like to ask about a 6-year-old boy who has developed a hemangioma on his foot, which has broken the skin and resulted in a wound with signs of proliferation.
He has been seen at other clinics, and the doctors informed us that due to his young age, surgery is not an option, and they only prescribed an ointment that requires weekly follow-ups for refills.
However, the ointment has not improved the condition and has even led to ulceration.
This situation has caused significant distress in the child's daily life, making it very difficult for both the mother and the teacher.
I would like to ask Dr.
Zhou if it is truly impossible to consider surgical intervention for this 6-year-old boy?

Xiao Hua, 30~39 year old female. Ask Date: 2010/02/01

Dr. Zhou Hongzhang reply Plastic Surgery

1.
A 6-year-old can still undergo surgery.
2.
According to the letter, this young boy appears to have a superficial hemangioma, which should be amenable to excision for complete healing.
3.
It is best to consult in an outpatient setting and have the physician examine the affected area to obtain the most accurate diagnosis and treatment.
Dr.
Hsiao-Hung Chang, Plastic Surgery.

Reply Date: 2010/02/01

More Info

Managing hemangiomas in young children, particularly in cases where they cause complications such as ulceration or significant discomfort, can be challenging. Hemangiomas are benign vascular tumors that are quite common in infants and young children. They typically undergo a natural course of growth and regression, but when they become problematic, as in the case of your 6-year-old son, intervention may be necessary.

Surgical Options
1. Observation: In many cases, especially when hemangiomas are not causing any complications, doctors may recommend a watchful waiting approach. Most hemangiomas will shrink and fade over time without any treatment. However, if the hemangioma is ulcerated, painful, or affecting the child's quality of life, this approach may not be suitable.

2. Medical Management: For hemangiomas that are problematic but not yet requiring surgery, topical treatments or systemic medications may be prescribed. Propranolol, a beta-blocker, has become a standard treatment for problematic hemangiomas. It can help reduce the size of the hemangioma and alleviate symptoms associated with ulceration. Corticosteroids may also be used, but they are less common due to potential side effects.

3. Surgical Intervention: If the hemangioma is causing significant issues, such as persistent ulceration, pain, or functional impairment, surgical removal may be considered. While it is true that surgery is often postponed until the child is older, it is not impossible to perform surgery on younger children. The decision to proceed with surgery depends on various factors, including the size, location, and symptoms associated with the hemangioma, as well as the overall health of the child.

Considerations for Surgery
- Age and Health: While younger children may have a higher risk associated with anesthesia and surgery, many pediatric surgical centers are equipped to handle these cases safely. The child's overall health and the hemangioma's characteristics will guide the decision.

- Location and Size: Hemangiomas located in sensitive areas, such as near the eyes or on the face, may require more careful consideration and potentially earlier intervention.

- Potential Risks: As with any surgical procedure, there are risks involved, including infection, scarring, and the possibility of the hemangioma returning. A thorough discussion with a pediatric surgeon or a dermatologist specializing in vascular lesions is essential to weigh the risks and benefits.

Postoperative Care
If surgery is performed, postoperative care will be crucial. This may include:
- Wound Care: Keeping the surgical site clean and dry to prevent infection.

- Pain Management: Administering appropriate pain relief as needed.

- Follow-Up Appointments: Regular check-ups to monitor healing and assess for any complications.

Conclusion
In conclusion, while it is common for doctors to recommend conservative management for hemangiomas in young children, there are circumstances where surgical intervention is warranted, especially when the hemangioma is causing significant distress or complications. It is essential to have a detailed discussion with a pediatric specialist who can evaluate your child's specific situation and recommend the best course of action. If you feel that your child's quality of life is being affected, seeking a second opinion from a pediatric dermatologist or surgeon may provide additional options for management.

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