Wu June K, Rohde Christine H
Division of Plastic Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Ann Plast Surg. 2009 May;62(5):581-5. doi: 10.1097/SAP.0b013e31819fb1e2.
Hemangiomas often leave contour deformities and scarring after involution. Surgical resection leaves permanent scars and may distort adjacent anatomy. Circular excision with purse-string closure results in the smallest possible scar and minimal distortion. Thirty-six patients with varying stages of hemangiomas underwent resection with purse-string closure. The dimensions of each hemangioma were 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. Thirty-six patients underwent circular excision and purse-string closure of 39 hemangiomas. Thirty (83.3%) were girls and 6 (16.7%) were boys. The ages of the patients ranged from 5 months to 13 years, with a median age of 2.08. The most common locations were: scalp 9 (23.1%), cheek 9 (23.1%), forehead 5 (12.8%), and eyebrow 4 (10.3%). The median area of the hemangiomas was 491 mm (range: 113-2826 mm2). Follow-up measurements were available for 25 patients with 33 hemangiomas. Follow-up ranged from 1 to 22 months (median follow-up, 3 months). The median area of the purse-string scar was 70.7 mm (range: 3.925-706.5 mm2). The median percentage reduction in area of involvement was 80.6% (range: 24.2%-99.1%). When the hemangiomas were stratified into "large" and "small" hemangiomas, the median percentage reduction in the areas were 84.1% and 79.2%, respectively. There were 3 complications: 1 patient scratched open her incision (ultimately 76% of original size), and 1 toddler scraped her scalp against the carpet and dehisced the purse-string closure (final size, 43% of original size), and a second toddler fell and dehisced a scalp hemangioma (final size, 80% of original size). Traditional lenticular excision of hemangiomas results in increased scar length as compared with the original lesion. Circular excision and purse-string closure of defects results in a scar smaller than the original lesion. It is well tolerated and can be considered the default method in most anatomic locations.
血管瘤消退后常遗留外形畸形和瘢痕。手术切除会留下永久性瘢痕，且可能使邻近解剖结构变形。荷包缝合的环形切除形成的瘢痕最小，对解剖结构的扭曲也最小。36例不同阶段血管瘤患者接受了荷包缝合切除术。在切除时测量每个血管瘤的大小。在随访门诊记录瘢痕的大小。最终瘢痕大小以病变原始大小的百分比计算。36例患者对39个血管瘤进行了环形切除和荷包缝合。30例（83.3%）为女孩，6例（16.7%）为男孩。患者年龄范围为5个月至13岁，中位年龄为2.08岁。最常见的部位为：头皮9个（23.1%）、面颊9个（23.1%）、前额5个（12.8%）、眉部4个（10.3%）。血管瘤的中位面积为491平方毫米（范围：113 - 2826平方毫米）。对25例患者的33个血管瘤进行了随访测量。随访时间为1至22个月（中位随访时间为3个月）。荷包缝合瘢痕的中位面积为70.7平方毫米（范围：3.925 - 706.5平方毫米）。受累面积的中位缩小百分比为80.6%（范围：24.2% - 99.1%）。当血管瘤分为“大”和“小”血管瘤时，面积缩小的中位百分比分别为84.1%和79.2%。出现了3例并发症：1例患者抓破切口（最终为原始大小的76%），1名幼儿头皮在地毯上擦伤导致荷包缝合裂开（最终大小为原始大小的43%），另1名幼儿摔倒导致头皮血管瘤裂开（最终大小为原始大小的80%）。与原始病变相比，传统的血管瘤透镜状切除会导致瘢痕长度增加。对缺损进行环形切除和荷包缝合形成的瘢痕小于原始病变。该方法耐受性良好，在大多数解剖部位可作为首选方法。
