Surgical Management of Infantile Hemangioma Using the Purse-String Technique: Impact on the Scar

Purpose : To asses scar size reduction using the Purse-String (PS) technique compared to elliptic resection for Infantile Hemangioma (IH).

Methods: Retrospective study of 431 patients with IH or its sequelae, referred to the multidisciplinary Center for Vascular anomalies between 2005 and 2012. Photographs taken before and after management were analyzed. Statistical analyses were conducted considering each tumor independently. The study was accepted by our local ethics committee. 57 patients underwent surgery, using the PS technique. Fourteen patients could not be used for analysis due to lack of information and two patients were operated using a PS for more than one IH. All tumors were measured by calculating the two diameters of an elliptic form covering the majority of the lesion. The predicted scar length for an elliptic resection, was taken as the double of the length of the shortest diameter. The scar lengths after PS were measured on the post-surgery photographs. Comparisons of the two were done using a Paired Sample T-Test.

Results : The 48 IH reviewed in our study had a mean surface area before surgery of 8.68 cm² (±7.43 cm²). 41 of them operated by PS presented a mean scar length of 2.57 cm (±1.25 cm) compared to a scar length estimation for an elliptic resection of 5.95 cm (±2.50 cm) (Paired T-test, P-Value < 0,001). The remaining seven (n=7/48, 14.58%) suffered from scar widening and the mean scar surface was 3.51 cm² (±2.72 cm²) opposed to an initial mean surface of 6.26 cm² (±2.37 cm²) before surgery (Paired T-test, P-Value = 0,019). Four patients needed scar revision and three patients underwent subsequent lipofilling.

Conclusion : The scar lengths after Purse-String surgery are shorter than those estimated for elliptic resection. This is statistically significant. Thus, the Purse-String technique is a useful tool in the surgical management of infantile hemangioma.