Hemangiomas in Children: Challenges and Outcome of Surgical Management in Benin City, Nigeria

Objective: Treatment of hemangioma/vascular tumors emphasize minimal invasion which require sophisticated facilities. This study reports the role of surgery in the management of symptomatic, and hemangioma which failed to respond to other modalities of treatment in resource-limited subregion.
Methods: A six-year (2004-2009) prospective study on the challenges and outcome of children referred for surgical management of hemangioma/vascular tumors was undertaken at the University of Benin Teaching Hospital, Nigeria.
Findings: Sixty-three children aged between a day and six years (median 5 years) comprising 38 males and 25 females (ratio 1.5:1) were managed. Upper limbs involvement, 18 (28.6%), and face/neck, 12 (19.1%), were most common and were present at birth in 27 (42.9%) babies, appeared between 2-3 weeks in 32 (50.8%), and after six months in 4 (6.3%). Cavernous hemangioma in 19 (30.2%) children, mixed cavernous/strawberry in 31 (49.2%) and strawberry in 13 (20.6), were the major types that ranged from spot-like to extensive huge lesions measuring 12×15 cm in diameter. Failure of 46 (65.1%) cases to respond to non operative treatment, ulceration in 3 (4.8%), infection in 5 (7.9%) and hemorrhage in 2 (3.2%) were indications for surgical intervention. Surgical options included complete excision and primary wound closure in 34 (54%) children, immediate skin graft after complete excision in 10 (15.9%), injection sclerotherapy in 2 (3.2%), serial ligation of feeder vessels in 2 (3.2%), and conservative treatment in 5 (7.9%). Excision and primary wound closure gave better outcome compared with others (P<0.0001). No mortality was recorded on 1-6 years follow-up but ugly scar, 8 (12.7%) and limb deformity, 3 (4.8%) were problems.
Conclusion: Surgical excision and primary wound closure gave good outcome which could be employed in complicated and hemangioma which failed to respond to other treatment in regions with limited resources.