The editors of The Journal of Craniofacial Surgery (JCS), in collaboration with the American Association of Pediatric Plastic Surgeons, invited international experts to share their views on the current concepts and controversies in treating children with vascular anomalies. The results appear in the July/August issue of JCS.

According to an introductory editorial by Mutaz B. Habal, MD, editor of JCS, physicians and surgeons have historically held inaccurate views regarding vascular anomalies. Hemangiomas, the most common vascular anomaly, are vascular “birthmarks” that can enlarge rapidly. Physicians say that because many hemangiomas are located on the head and neck, they may cause serious aesthetic problems. Depending on location, damage to the eye or other structures can also occur.

A major problem, Habal says, is that many physicians have been taught that all hemangiomas will disappear within a short time. However, he notes, this is not true—these vascular tumors do not disappear like magic. Some hemangiomas do shrink over time, but may leave behind an area of baggy skin. Others grow very large and cause serious disfigurement if untreated.

Habal adds that for many patients  this widespread misconception has led to delays in treatment, aesthetic and psychological issues and problems with scarring when surgery eventually is performed—not to mention litigation windfalls. Confusion over diagnosis leads to inaccurate identification of vascular tumors and further delays in treatment.

The development of effective laser techniques has been a major advance in the treatment of vascular anomalies. In a new advance, laser treatment may be performed intralesiona- lly—from the inside out. When needed for larger, more complex vascular lesions, modern surgical techniques and skin grafts provide good results. If these procedures are done on children, any resulting scars are more easily managed by plastic surgery later on. In some situations, certain drug therapies may play a role.

The JCS editors expressed hope that continued scientific and clinical research will lead to new therapeutic advances that will provide patients and families with new hope and successful outcomes.

[www.newswise.com, September 29, 2006]