title: Purse-string closure of hemangiomas: early results of a follow-up study.
abstract: 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.
authors.affiliation: Division of Plastic Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. jw92@columbia.edu
authors.forename: June K
authors.initials: JK
authors.lastname: Wu
authors.forename: Christine H
authors.initials: CH
authors.lastname: Rohde
mesh_terms: D002610:Cheek; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control*; D005138:Eyebrows; D005260:Female; D005500:Follow-Up Studies; D005546:Forehead; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006391:Hemangioma / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012535:Scalp; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome