Purse-string Closure of Hemangiomas Early Results of a Follow-up Study

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 front 5 months to 13 years, with a median age of 2.08. The most common locations were: scalp 9 (23.1%), check 9 (23.1%), forehead 5 (12.8%). and eyebrow 4 (10.3%). The median area of the hemangiomas was 491 mm(2) (range: 113-2826 mm(2)). Follow-up measurements were available for 25 patients with 33 hemangiomas. Follow-up ranged from I to 22 months (median follow-up, 3 months). The median area of the purse-string scar was 70.7 mm(2) (range: 3.925-706.5 mm(2)). The median percentage reduction in area of involvement was 80.6% (range: 24.2%-99.19%). 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: I patient scratched open her incision (ultimately 76% of original size), and I 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.