Victoria M. Vander Kam

Management of hemangioma of infancy: review of 245 patients.

A retrospective study of patients treated from May of 1981 to April of 1994 was conducted. A total of 245 patients with 299 hemangiomas were studied, which represents the largest series reported to date. The study consisted of 173 females and 72 males ranging in age from 1 day to 59 years, with the average age being 4 years and 7 months. Twenty-six were premature neonates (14 females and 12 males). An interesting finding was a 1:1 sex ratio among this group in contrast to the 3:1 female-male ratio frequently reported in the literature. Onset was at birth in 170, within the first month in 43, and after the age of 1 month in 32 patients. Among the 245 patients, 175 hemangiomas were located on the head and neck, 62 on the trunk, 49 on the extremities, and 13 in the perineal area. Five groups of patients were defined based on clinical management. As a result, these groups are not similar. The five groups are as follows: group I (48), observation; group II (9), steroid treatment; group III (27), excision and reconstruction; group IV (88), laser therapy; and group V (73), combined therapy. The involved area of hemangioma was as follows: group 1, 0.5 x 0.5 to 20 x 8 cm; group II, 2 x 2 to 8 x 8 cm; group III, 0.4 x 0.8 to 7 x 7 cm; group IV, 0.5 x 0.5 to 20 x 9 cm; and group V, 1.5 x 1.5 to 25 x 25 cm. The complications of hemangioma seen at the time of consultation were obstruction (28.6 percent), ulceration (20.4 percent), bleeding (14.7 percent), infection (4.9 percent), and pain (0.4 percent). Treatment periods ranged from 1 month to 11 years, with the mean period in each group as follows: group I, 4 years and 9 months; group II, 2 years and 5 months; group III, 1 year and 1 month; group IV, 2 years and 1 month; and group V, 3 years. The outcomes of each patient were evaluated based on improvement of volume, color, and texture by the following scale: 1, poor (0 to 25 percent); 2, fair (26 to 50 percent); 3, good (51 to 75 percent); and 4, excellent (76 to 100 percent). Each of these parameters was summarized for each of the five groups. Statistical analysis by the Irwin-Fisher test was used for analysis and comparison of the final results between groups. Statistically significant differences in outcomes between treatment groups were demonstrated. Laser therapy was shown to be statistically superior to observation with regard to length of treatment and with regard to outcomes of volume and texture (p < 0.05).

Treatment of traumatic tattoos by Q-switched ruby laser.

The Q-switched ruby laser is currently used in the treatment of amateur and professional decorative tattoos. The present study documents the clinical management and follow-up of 12 subjects with traumatic tattoos treated with the Q-switched ruby laser. The results of this study indicate that an excellent clinical outcome can be achieved with substantial removal of the targeted foreign pigmented matter while potential adverse effects are significantly reduced. Hypopigmentation, which occurred in four patients (33.3 percent), was temporary and resolved spontaneously in all subjects within 6 months of laser exposure. There was no hypertrophic scarring, atrophy, or induration seen in any of the subjects treated with the Q-switched ruby laser. (Plast. Reconstr. Surg. 93: 318, 1994.)

Capillary Hemangioma (Strawberry Mark) of Infancy: Comparison of Argon and Nd

Capillary hemangioma of infancy (strawberry mark) is a self-limiting problem, and conservative treatment is recommended. These birthmarks can be associated with a great deal of morbidity. There is definitely a role for a palliative form of treatment without systemic complications or destruction of adjacent tissue. In a 6-year period, 55 patients received 57 Nd:YAG or argon laser treatments. Thirty patients received 31 argon treatments, and 25 patients received 26 Nd:YAG treatments; and 2 received first argon with subsequent Nd:YAG treatments. Although more dramatic successes were noted in the Nd:YAG laser, complications were more frequent and severe. Complications included delayed healing, postoperative bleeding, and some hypertrophic scarring. Complications were seen in 12 percent of all patients, 9 percent of these associated with the Nd:YAG laser.

Electrical burn injury to the upper extremity

Our experience with a group of 22 patients with electrical injuries to the hand is reported. Some guidelines in management are formulated.

Clinical experience with the pulsed-dye laser in the treatment of capillary malformations (port-wine stains): a preliminary report.

This preliminary report reviews a series of 70 patients treated with tunable-dye laser therapy for congenital capillary malformations (port-wine stains). Results were reviewed according to age and ethnic group of patients and color and anatomical location of malformations. Red birthmarks were most responsive to treatment in all age groups in all anatomical locations. Purple birthmarks were generally less responsive to laser treatment except in children, who responded well. Scarring and hypopigmentation were minimal (5.7% and 1 %, respectively), even in nonwhite patients. Recommendations emerging from this study include testing of infants, as results may vary. Detrimental side effects are rare. A major goal in treating port-wine stains is to avoid both the progression of these lesions through life and the psychological complications that occur during early socialization years in childhood. Pulsed-dye laser treatment offers much promise in these areas.

Lasers in plastic surgery and dermatology

Laser physics and laser-tissue interactions laser systems used in plastic surgery and dermatology benign skin lesions premalignant and malignant skin lesions vascular malformations hemangiomas management of difficult vascular birthmarks telangiectasia and miscellaneous vascular lesions pigmented lesions mucous membrane conditions viral conditions nail diseases scars tattoos pressure ulcers laser safety for plastic surgery and dermatology perioperative considerations for laser surgery setting up a laser practice future challenges of laser medicine.

Results of a survey of cleft palate teams concerning the use of nasendoscopy

A national survey was conducted concerning methods used for the evaluation of velopharyngeal function with emphasis on the role of nasendoscopy. Forty-five percent of questionnaires were returned. Ninety percent of the responding teams indicated that nasendoscopy was available. Sixty-one percent agreed that endoscopy was an important clinical tool and not solely a research tool. The majority (59%) considered 3 to 5 years of age to be the youngest, appropriate age for referral. Ninety percent agreed that nasendoscopy was indicated for difficult diagnostic problems and 41% reported endoscopic studies were appropriate for all patients for whom secondary palatal management is planned. The results of this survey suggest that endoscopic assessment of velopharyngeal function is used routinely as an adjunct to the perceptual evaluation of speech and has become the standard of care among cleft palate teams for difficult diagnostic cases. However, the data also indicate that increased availability does not necessarily assure optimal use.

Treatment of vitiligo with melanocytic grafting.

This case report documents the treatment of extensive vitiligo with melanocytic grafting using ultra-thin, split-thickness skin grafts. Results, limitations, and disadvantages are discussed.

Management of Vascular and Premalignant Nevi in the Pediatric Population

Successful management of the pediatric patient is a challenge to plastic surgery nurses as they work in tandem with surgeons to guide the family through the treatment process. This article will discuss the treatment of a number of congenital birthmarks, specifically congenital vascular birthmarks and congenital nevi, which have a potential for malignant transformation.