title: Haemostatic squeezing and purse-string sutures: optimising surgical techniques for early excision of critical infantile haemangiomas.
abstract: OBJECTIVE
  Surgical excision of critical infantile haemangiomas (HMs) is usually delayed until intralesional blood flow spontaneously decreases, but fibrofatty tissue and exuberant skin invariably remain even after total involution. The aim of this study was to describe 2 surgical techniques used for early excision in 50 selected cases of HM defined critical in site or size.
  
  
  METHODS
  Among a total of 952 patients affected by HM observed from 1999 to 2005, 50 children (5.2%) were submitted to early surgical removal of the tumour (age range, 6-24 months). In group 1, a technique of lenticular incision and linear closure was used in 34 patients using an original clamp for haemostasis during excision. In group 2, a modified round-block excision and purse-string closure technique was performed in 16 patients.
  
  
  RESULTS
  Only 2 patients required transfusion to replace intraoperative blood losses. Infection, delayed wound healing, and cheloids occurred in 3 patients in group 2. Satisfactory cosmetic results have been observed in most cases in both groups at a follow-up ranging from 6 months to 6 years.
  
  
  CONCLUSIONS
  The range of indications for early surgical removal of critical HM might be enlarged to achieve earlier the better cosmetic results. A few surgical tricks can minimize intraoperative bleeding and optimise the surgical scar.
authors.affiliation: Vascular Surgery Unit, V.Buzzi Children's Hospital, 20154 Milan, Italy. vittoria.baraldini@tiscalinet.it
authors.forename: Vittoria
authors.initials: V
authors.lastname: Baraldini
authors.forename: Michele
authors.initials: M
authors.lastname: Coletti
authors.forename: Francesca
authors.initials: F
authors.lastname: Cigognetti
authors.forename: Gianni
authors.initials: G
authors.lastname: Vercellio
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D002675:Child, Preschool; D002921:Cicatrix / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000175:diagnosis / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012878:Skin Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology