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Plastic Surgery - Regional Paediatric Burns and Plastic Surgery Service

placeholder1A common cause of birthmarks in children is the abnormal development of arteries, veins and lymphatics. These birthmarks vary considerably in appearance, functional effects and prognosis. Treatment of these abnormalities is extremely important for the child and the family for both cosmetic and functional reasons, and varies according to the type and location of the lesion.

At the Alder Hey Vascular Birthmark Centre we run a weekly general clinic, and a monthly multidisciplinary clinic chaired by Mr S Liew, Consultant Plastic Surgeon. The multidisciplinary clinic is also attended by Dr A Healey, consultant radiologist and Mrs C Gorst, laser nurse specialist. It also has the back up of specialists from dermatology, ENT, ophthalmology and oncology. Since its establishment in 1997, we have seen patients from all over England, Scotland, Wales, Isle of Man and as far afield as Poland.

We treat all types of vascular anomalies, and also offer a wide range of laser treatments for various conditions:

• V beam laser for vascular lesions such as port wine stain, spider naevus and telangiectasia
• Q-switched Nd:YAG laser for pigmented lesions
• Erbium laser for resurfacing of scar and ablation of epidermal lesions
• Long pulsed Nd:YAG laser for venous malformation
• Long pulsed Nd:YAG laser for unwanted facial and body hair due to hormonal problems

 

Common Vascular Anomalies

 

Congenital Pigmented Naevus

We do not know why some children are born with congenital pigmented naevi. This is essentially a ‘mole’ which can vary in colour from very light brown to almost black, and size, from very small to large – covering extensive areas of the body.

Does congenital pigmented naevus need treatment?

No, most are innocent. However, treatment may be desirable to improve the cosmetic appearance.

What treatment options are available?

Laser treatment-this aims to lighten the colour of the naevus. Some patients respond better than the others, and several treatments are usually needed. Laser treatment, however, will not eliminate the naevus completely. Even if good result is achieved after several treatments, the colour will return if the area is exposed to sunlight.

Surgery-various options exist depending on the size of the naevus, and its location. This will be discussed with you in the clinic.

What is laser treatment?

Laser treatment for pigmented birthmark involves a specific light source that targets the abnormal pigmentation in the skin. It aims to lighten the colour of the birhtmark. Usually 2-3 treatments are given at 6 weekly interval. Further laser treatment could be given if the result is favourable.

Will my child require an anaesthetic?

In younger children, laser treatment is generally carried out under general anaesthesia.

In older children, treatment may be possible under local anaesthesia (a numbing cream is applied to the port wine stain prior to treatment), or with entonox (pain killing gas that the child breathes). The suitability of each treatment will be tailored to the age and maturity of your child.

What are the side effects of laser treatment?

There can often be some scabbing, bruising and swelling In the area that has been treated but this will normally clear up within five days.

What is the after care?

When you go home the area may be swollen and scabbed for a few days,you will need to keep the area clean and dry. If the areas become oozing or smelly you will need to contact the Laser Unit.

For further information please contact:
The Laser Nurse Specialist
Direct line 0151 252 5402    or 0151 228 4811    ext 2402
Fax 0151 252 5932

This page only gives general information. You must always discuss the individual treatment of your child with the appropriate member of staff. Do not rely on this fact sheet alone for information about your child’s treatment.

 

 

 

Haemangioma

A haemangioma is a collection of abnormal blood vessels. It is not usually present at birth, but appears as a small red mark at about 2 weeks of age. It grows during the first few months of life, where its size becomes bigger, and colour becomes redder.

The growth phase normally stops when a child is about 9 months old. Thereafter, it gradually reduces in size and colour.

Will my child need treatment?

Since haemangioma reduces in size and colour at its own accord, treatment is usually not needed. However, in certain circumstances, when its growth is very rapid, or if it is interfering with normal functions e.g. blocking the vision, or causing difficulty in breathing, urgent treatment is needed. Treatment is also given when haemangioma bleeds.

The resolution of haemangioma can take many years, and sometimes the resolution may not be complete. We will monitor your child regularly in our clinics, and if it does not resolve completely by school age (4 years old), we will intervene to ensure that your child does not attend school with obvious disfigurement. Early, unnecessary treatment (e.g. surgery) may result in unwanted scars.

What treatment options are available?

Treatment of haemangioma depends on whether its undertaken to halt its growth (i.e. when your child is very young), or to address the cosmetic effect of haemangioma (i.e. before your child goes to school).

Early treatment to halt the growth of a haemangioma involves:

  • Propranolol-a heart medication that has been shown to be effective in stopping haemangioma growth.
  • Steroids-either given by injection or orally.
  • Laser treatment-usually combined with injection of steroid.

Late treatment if a haemangioma does not completely disappear by school age:

  • Surgery-to remove any residual haemangioma or loose skin
  • Laser treatment-to remove the residual colour of haemangioma

Each of these treatment options will be explained to you in the clinic. A treatment plan will be discussed to ensure that your child achieves the best treatment result.

How do I contact the team?

For further information, please contact:

Laser Nurse Specialist. Direct line: 0151 252 5402    or Vicky Gough, Laser Secretary on 0151 252 5510

This page only gives general information.You must always discuss the individual treatment of your child with the appropriate member of staff. Do not rely on this page alone for information about your child’s treatment.

 

 

Port Wine Stain

The cause of port wine stain (capillary malformation) is unknown. it is made up of a collection of abnormal blood vessels in the skin.

What are the treatment options?

Laser treatment is the treatment of choice for port wine stain.

Cosmetic camouflage can be useful on the face. However, it may not be practical to apply it in younger children, and on certain body areas where it can smear the clothing.

Surgery is not an option in the treatment of port wine stain.

What will happen if the port wine stain is not treated?

If not treated it is possible that, in adulthood, the port wine stain could become darker and thicker.

When would treatment start?

We would start treatment from one year old. There is evidence that treatment is more successful in younger children as their blood vessels are smaller.

What is laser treatment?

Laser treatment for port wine stain involves a specific light source that targets the abnormal blood vessels in the skin. The light source heats up the abnormal blood vessels, causing them to coagulate and stop further blood flow in the area. Laser treatment aims to lighten the colour of the port wine stain. Usually treatment is given at 6 weekly interval. On average, 6-8 treatments are needed to achieve the optimum results.

How successful is laser treatment?

Each child responds differently to laser treatment. After laser treatment, there is usually lightening of the colour of the port wine stain. The end results varies between children, and on different parts of body. In general, port wine on the face responds better than those on the limbs.

This treatment can only be carried out at six weekly intervals in order to allow the skin to recover.

Will my child need an anaesthetic?

In younger children, laser treatment is generally carried out under general anaesthesia.

In older children, treatment may be possible under local anaesthesia (a numbing cream is applied to the port wine stain prior to treatment), or with entonox (pain killing gas that the child breathes). The suitability of each treatment will be tailored to the age and maturity of your child.

What are the side effects of laser treatment?

Immediately after treatment, the treated area will bruise, and has a blue black colour. This takes about 7-10 days to resolve. There is a small risk of scarring to the treated area.

What is the aftercare after laser treatment?

You will need to keep the area clean and dry. If the areas become red and swollen you will need to contact us. The area is usually not very painful after treatment. Simple analgesia i.e. paracetamol could be given if necessary.

How do I contact the team?

For further information, please contact:

Laser Nurse Specialist: 0151 252 5402    or
Laser Secretary, Vicky Gough: 0151 252 5510

You must always discuss the individual treatment of your child with the appropriate member of staff. Do not rely on this page alone for information about your child’s treatment

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