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Division of
Plastic Surgery
Hemangiomas and Vascular Malformations
Benjamin Chang
B. Chang
David Low
D. Low
Joseph Serletti
Dr. Serletti

There are two types of blood vessel problems that occur in children, and it is important to distinguish between the two to provide a proper diagnosis, prognosis, and treatment plan. History and physical examination can correctly diagnose the vast majority of patients, although additional diagnostic scanning may be helpful.

HemangiomaThe most common are hemangiomas, which are composed of proliferating (multiplying) tiny blood vessels known as capillaries. Hemangiomas occur in up to 10% of infants, making them the most common benign tumor of infancy. Girls are affected three times as often as boys are.  Most are not present at birth, but appear during the first few weeks of life. Superficial hemangiomas grow in the dermis layer of the skin and commonly begin as small strawberry-colored dots that progressively enlarge. Subcutaneous hemangiomas grow beneath the skin and appear blue, and many hemangiomas have both a superficial and a deep component. Many physicians still incorrectly call subcutaneous hemangiomas "cavernous hemangiomas". They may think the blue color is due to larger vessels, when it is actually their deeper location that gives the capillaries a blue hue. Hemangiomas may also grow internally, involving areas such as the parotid gland, the eye region, the airway, and the liver. The majority of hemangiomas occur in the head and neck area, but they can grow anywhere. Infants can have more than one hemangioma, and they often vary in size and grow at different rates.

All hemangiomas eventually stop growing, usually between 6 and 12 months of age. After the proliferative phase ends, the hemangiomas slowly involute over an average of 5 years. The blood vessels shrink, the size decreases, and the color lightens. While all hemangiomas will exhibit regression, and many will not require any treatment whatsoever, some can be life threatening or vision threatening, and others can cause significant scarring and distortion of facial features. Treatment ranges from conservative observation to steroid therapy, laser therapy, surgical intervention, and interferon therapy. Small hemangiomas are initially managed most appropriately by pediatricians, but those of concern are often referred to pediatric dermatologists and pediatric plastic surgeons for further evaluation and management.

Vascular malformations are much less common than hemangiomas, and are often incorrectly diagnosed as hemangiomas. Microscopically they are composed of abnormally formed capillaries, veins, lymphatics, and/or arteries that are usually larger and weaker than normal vessels. Unlike hemangiomas there is no proliferation phase. Vascular malformations appear to grow because the vessels progressively dilate; they are not multiplying and dividing. Conversely, there is no regression phase. Vascular malformations do not go away, and it is important for parents to understand that this is a lifelong condition.

Types of vascular malformations include:
Capillaries often called port wine stains
Veins venous malformations
Lymphatics lymphatic malformations (often still called lymphangiomas and cystic hygromas)
Arteries arteriovenous malformations
Combinations Klippel-Trenaunay syndrome has abnormal capillaries, veins, and lymphatics, often with overgrowth of the involved region
Sturge-Weber syndrome may involve abnormal capillaries in the upper face, with glaucoma, seizures, and possible brain involvement

Treatment of vascular malformations may include laser therapy, sclerotherapy, selective embolization, surgical debulking, and compression garments.

The Hemangioma and Vascular Malformation Clinic at the Children's Hospital of Philadelphia is a multidisciplinary team comprised of plastic surgeons, interventional radiologists, and dermatologists with a strong interest in evaluating and treating these disorders. Additional specialists in oculoplastic surgery, orthopedic surgery, otolaryngology, neurosurgery, and pediatric general surgery may be involved in the care of patients whose hemangiomas and vascular malformations require their expertise. Pediatric patients are seen in the offices of the Division of Plastic Surgery, 1st floor, Wood Ambulatory Care Building, 34th and Civic Center Boulevard, Philadelphia, Pennsylvania 19104. Adults with vascular malformations are seen at the offices of the Division of Plastic Surgery, Perelman Center for Advanced Medicine, Philadelphia, PA 19104.

Inpatient Facilities:
Hospital University of Pennsylvania (HUP)
Children's Hospital of Philadelphia (CHOP)
Office Visit Locations:
Perelman Center for Advanced Medicine
Center for Human Appearance, Suite 1-150E (HUP)
34th Street and Civic Center Boulevard (CHOP)
Making an Office Visit Appointment:
1-800-789-PENN (HUP) or 215-590-2208 (CHOP)

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