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Hemangiomas in Children: Challenges and Outcome of Surgical Management in Benin City, Nigeria
Osifo, Osarumwense David & Evbuomwan, Iyekoretin
Abstract
Objective: Treatment of hemangioma/vascular tumors emphasize minimal invasion which require
sophisticated facilities. This study reports the role of surgery in the management of symptomatic,
and hemangioma which failed to respond to other modalities of treatment in resource-limited
subregion.
Methods: A six-year (2004-2009) prospective study on the challenges and outcome of children
referred for surgical management of hemangioma/vascular tumors was undertaken at the
University of Benin Teaching Hospital, Nigeria.
Findings: Sixty-three children aged between a day and six years (median 5 years) comprising 38
males and 25 females (ratio 1.5:1) were managed. Upper limbs involvement, 18 (28.6%), and
face/neck, 12 (19.1%), were most common and were present at birth in 27 (42.9%) babies,
appeared between 2-3 weeks in 32 (50.8%), and after six months in 4 (6.3%). Cavernous
hemangioma in 19 (30.2%) children, mixed cavernous/strawberry in 31 (49.2%) and strawberry
in 13 (20.6), were the major types that ranged from spot-like to extensive huge lesions measuring
12×15 cm in diameter. Failure of 46 (65.1%) cases to respond to non operative treatment,
ulceration in 3 (4.8%), infection in 5 (7.9%) and hemorrhage in 2 (3.2%) were indications for
surgical intervention. Surgical options included complete excision and primary wound closure in
34 (54%) children, immediate skin graft after complete excision in 10 (15.9%), injection
sclerotherapy in 2 (3.2%), serial ligation of feeder vessels in 2 (3.2%), and conservative treatment
in 5 (7.9%). Excision and primary wound closure gave better outcome compared with others
(P<0.0001). No mortality was recorded on 1-6 years follow-up but ugly scar, 8 (12.7%) and limb
deformity, 3 (4.8%) were problems.
Conclusion: Surgical excision and primary wound closure gave good outcome which could be
employed in complicated and hemangioma which failed to respond to other treatment in regions
with limited resources.
Keywords
Hemangioma; Cavernous Hemangioma; Strawberry Hemangiomas; Children
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