Surgical removal of haemangiomas

This page explains about surgical removal of haemangiomas and what to expect when your child comes to Great Ormond Street Hospital (GOSH) to have this treatment.

A haemangioma is a collection of small blood vessels that occur under the skin. They are sometimes called ‘strawberry marks’ because the surface of a haemangioma looks a bit like the surface of a strawberry.

Haemangiomas can be on the surface of the skin or in the skin. Some haemangiomas are a combination of the two, with a raised, red area on the surface of the skin, and a bluish swelling of abnormal blood vessels deeper in the skin.

Sometimes they can be removed by surgery. Not all haemangiomas are suitable for this form of treatment.

Surgery is an option for removing a haemangioma but this depends on its size and location. Generally, surgery is suggested for ‘functional’ reasons, for instance, if a haemangioma is interfering with breathing or feeding.

The surgeon will remove the haemangioma tissue and join the healthy skin together. There will always be a scar with this sort of operation, but the degree of scarring varies depending on the size and location of the haemangioma. Haemangiomas are not usually removed for cosmetic reasons as after a number of months they will start to reduce in size.

The risks of a haemangioma removal operation are the same as for other types of surgery. There is a small risk with any anaesthetic, but anaesthetics are now very safe and your child’s anaesthetist is an experienced doctor trained to deal with any complications. There is a small risk of infection but your child will have antibiotics to reduce this. There is also a small risk of bleeding after surgery, but using a dressing over the operation site will reduce this.

You will receive information on how to prepare your child for the operation in his or her admission letter. The surgeon will see you to explain the surgery in more detail, discuss any worries you may have and ask you to give permission for the surgery by signing a consent form. If your child has any medical problems, such as allergies, please tell the surgeon.

Your child may be sleepy after the operation due to the anaesthetic. The operation site will feel sore afterwards and will need careful looking after for the first week. A regular dose of paracetamol, given according to the instructions on the bottle or packet, is usually enough to take away the pain. Your child will usually spend one night in hospital after the operation to remove a haemangioma, and will be able to go home the next day when he or she is feeling better. The operation site may be covered with a dressing to protect it for the first few days.

When you go home you will be told how long the dressing must stay on for as this depends on the size of the haemangioma. The stitches will most likely be dissolvable in the wound and there may be paper stitches over the wound. After the dressing is removed you can wash the area as normal, being gentle and drying thoroughly. The consultant will want to see you again to review the wound and advise you on appropriate scar care one to two weeks after surgery. All appointment details will be sent to you in the post.

You should call the ward if:

• Your child is in a lot of pain and pain relief does not seem to help
• Your child has a temperature of 38°C or higher and paracetamol does not bring it down
• The operation site oozes or starts to smell