Lenticular Excision Research Articles

Circular Excision and Purse-String Closure for Pediatric Facial Skin Lesions.

Standard resection of pediatric facial skin lesions consists of lenticular excision and linear closure. This one-stage procedure for circular lesions results in a linear scar 3 times longer than the diameter of the removed specimen. Circular excision and purse-string closure has been described for infantile hemangiomas to reduce the length of scar. The purpose of this study was to analyze the application of this technique for any type of circular facial skin lesion in the pediatric population. Records of consecutive pediatric patients with facial skin lesions treated with circular excision and purse-string closure from 2007-2014 were reviewed. Patient age, sex, type of lesion, location, and size were recorded. Number of stages necessary to remove the area and complications were analyzed. Seventy-seven children (74% female) underwent circular excision and purse-string closure for an infantile hemangioma (46%), pigmented nevus (27%), Spitz nevus (7%), pilomatrixoma (5%), pyogenic granuloma (5%), vascular malformation (4%), or another type of skin lesion (6%). Age at the time of resection was 6.0 years (range 4 months-17 years) and mean lesion area was 3.9 cm (range 0.2-19.6); 30% of patients underwent a second procedure and no infection or wound dehiscence occurred. Circular excision and purse-string closure is an effective technique to manage any type of circular skin lesion in the pediatric population. It is particularly useful for lesions on the face because it limits the length of a scar. A subset of patients may benefit from second procedure to convert the circular scar from a circle into a line.

Surgical treatment of anogenital hemangiomas of infancy

Abstract Introduction Infantile hemangiomas (IHs) are the most common benign tumors of the soft tissue in infants and children and they often represent a serious challenge for the treating physician. Hemangiomas located in the anogenital region represent only about 1% of all IHs, but raise special concerns as they have the propensity to ulcerate. This condition may appear spontaneously, or could result from therapeutic procedures. Ulceration is extremely painful and takes many weeks of conservative therapy to heal. Material and Methods. The aim of this study is to present the surgical approach of the IHs located in the anogenital area and the outcomes of this treatment option. Results. During a period of 36 months, 11 children (nine girls, two boys) were referred to our plastic surgery department with hemangiomas involving the anogenital, groin and perineum areas. The average follow-up period was of 8 months, during which 82% of cases experienced complications, especially ulceration. All the target hemangiomas were removed through a lenticular excision and the wound closed with a linear suture. Conclusions. Our study has shown that surgical excision of a complicated anogenital hemangioma or of a “healthy” hemangioma at high risk for ulceration in the anogenital region is an effective treatment, with fast healing and complete resolution of the pathogenic condition. Lenticular excision and linear closure represent a convenient surgical technique that can be performed as early surgery, during the proliferative stage, or at any time later, when the patient needs treatment, in safety conditions and with good results.

편측성 불완전 소구순열의 치료

Cleft lip arises from congenital underdevelopment with various degrees and patterns. Mulliken named a unilateral incomplete cleft lip with no severe cleft as a lesser-form cleft lip and categorized it into three subgroups. Anatomically categorized subgroups are minor-form, microform, and mini-microform cleft by the extent of vermilion-cutaneous dysjuntion. The vermillion cutaneous notch is more than 3 mm from the regular Cupid's bow peak for minor-form, less than 3 mm for microform, and almost no gap with discontinuity on the vermillion cutaneous border for mini-microform. The treatments are rotational advancement flap for minor-form, double unillimb Z-plasty for microform, and vertical lenticular excision for mini-microform, respectively. This article aims to present the literature review about the incomplete lesser form cleft lip classified by Mulliken and to report our experiences.

Treatment of nasal hemangiomas

Hemangiomas are the most common soft tissue tumors of infancy. Almost 60% of these tumors develop in the head and neck region. Nasal hemangiomas, distort human physiognomy and leave long lasting psychological sequelae. Conservative approach (intralesional corticosteroids, laser) may accelerate involution. Proponents of an early surgery suggest that aesthetic improvement during a critical period in child development can be achieved. Fourteen patients with nasal hemangioma were treated during 5-year period (2003–2007) with intralesional corticosteroids, lenticular excision, open rhinoplasty excision, and circular excision with “purse string suture”. The first line of treatment for large nasal hemangiomas is intralesional corticosteroids. Excision is indicated for small hemangiomas, while subtotal excision is preferable for large nasal hemangiomas. Circular excision and “purse string suture” is appropriate for prominent hemangiomas with predominant deep component. In our opinion surgery with maximal care for nasal architecture is the treatment option for nasal hemangioma.

Purse-string Closure of Hemangiomas

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.

Circular excision and purse-string suture technique in the management of facial hemangiomas

Hemangiomas are the most common soft tissue tumors in infancy. Treatment options for hemangiomas are numerous. The scar after lenticular excision and linear closure is often unacceptable. Localized cutaneous infantile hemangioma acts like a tissue expander. Therefore, circular excision and purse-string suture technique are applicable for hemangioma at any stage. For 2-year period we have operated 14 patients with hemangioma using circular excision and purse-string suture technique. In eight patients hemangioma was localized in the head and neck region. Two infants with large hemangioma of the face are presented in this article. One patient had hemangioma with ulceration resistant to conservative treatment. Second patient had giant hemangioma, which caused partial disturbation of visual axis. We applied circular excision and purse-string suture technique in both patients. The results were good, without any postoperative complications.

Biwinged excision for round pedal lesions

A technique for excising round pedal skin lesions is presented as an alternative to standard elliptic or lenticular excision. Biwinged excision maximally preserves healthy tissue and allows complete excision of a wide variety of lesions from the foot. The authors present a procedural outline of this technique and include several illustrative cases to demonstrate its utility.

Tracheotomy scar revision using deepithelialized subcutaneous pedicled flaps

Optimal revision of the typical tracheotomy scar requires release of any tracheal adhesions, elimination of the co-existing central depression, and a redirection of the usual circular scar. All these objectives may simultaneously be achieved by designing a horizontal lenticular excision around the scar that is then deepithelialized to form two subcutaneous-pedicled flaps. These are advanced together over the trachea to provide necessary central tissue bulk while serving as an additional buried layer for the skin closure to glide over, which usually creates an acceptable transverse scar.

Upper Eyelid Ptosis Correction by a Revised Tarsal Resection Technique

Many techniques have been developed for the correction of eyelid ptosis. A new tarsal plate resection technique is described for use in cases of minimal ptosis with fair to good levator function. The procedure involves a horizontal lenticular excision of the tarsal plate, placed so that equal amounts of tarsus remain above and below the excision. The height of the excision is equal to the amount of ptosis correction desired, as determined in the preoperative examination. This precision in surgical correction is the chief advantage of the procedure. The technique also spares Müller's muscle, thus retaining the lid-elevating action of that muscle. Good results have been achieved in 6 patients, some showing excellent results after nine years.