Authors (including presenting author) :
PL Tong(1), D Luk(1), YY Lam(1), JW Cheng(1), A Wu(1), CM Yau(1), PK Ma(1), WK Chiu(1)
Affiliation :
(1) Department of Paediatrics and Adolescent Medicine, United Christian Hospital
Introduction :
Infantile haemangioma is the most common vascular birthmark which usually follows a benign course of spontaneous resolution in the first decade of life. Unfortunately, 5-10% will ulcerate during the rapid proliferative phase in the first 6 months of life, especially for those located at areas with moisture and friction i.e. the lips, ears, eyelids or perineum. Ulceration may subsequently be complicated by infection or severe deformity. Management of ulcerated haemangiomas in the perineum is always a challenge for healthcare professionals. We reported an 18-day-old baby girl with multiple ulcerated haemangiomata around her perineum with potential risk of need for diversion colostomy. She was initially admitted to a regional hospital for enlarging ulcerated haemangiomata over her perineum. There was minimal improvement despite application of several advanced wound-dressing materials. One of the challenges of wound care was that the dressings were always soaked by urine and stool. At 28 days of age, she was transferred to our hospital for laser therapy and wound management. At the time of admission, there were three full-thickness ulcers over the haemangiomata around the anus. The one nearest to the anus (located 3mm from the anus) measured 3.5cm x 2.2cm. The other ulcers measured 2.5cm x 1.8 cm and 0.7cm x 1cm.
Objectives :
To evaluate the management of ulcerative infantile hemangioma at the perineum in order to identify the key factors leading to its successful management.
Methodology :
This is a clinical case report of an 18-day-old baby girl with an ulcer on both buttock as a complication of infantile hemangioma. Key clinical features were identified and specific treatments were detailed. These findings were then discussed with respect to the currently available clinical evidence.
Result & Outcome :
Result We reported a case of multiple infantile hemangiomas which appeared on the perineum a 5-day-old baby girl. Spontaneous ulceration of the haemangiomas was noted on 18 days of age without preceding traumatization or infection. The ulcers gradually enlarged despite initial conservative management using topical antibiotic and advanced wound-dressing method. Wound swab for culture revealed no growth of bacteria. One of the challenges of wound care was that the dressings were always soaked with urine and stool. At 28 days of age, she was transferred to our hospital for laser therapy and wound management. At the time of admission, there were 3 full-thickness ulcers over the haemangiomata around the anus, with the nearest one located 3mm from the anus, and measuring 3.5cm x 2.2cm in size. The other ulcers measured 2.5cm x 1.8cm and 0.7cm x 1cm. Specific treatments included 1) oral propranolol at 0.25mg/kg/day and gradually stepping up to 1mg /kg/day divided doses for 6-9 months, 2) Pulsed Dye Laser for four times, and 3) a variety of advanced dressing products which included hydrogel, alginate, hydrocolloid, hydrofibre and stomalhesive powder . A multidisciplinary care approach involving Paediatricians, Surgeons, Paediatric nurses and Enterostomal Therapy Nurses was implemented in the care of this patient. The ulcers subsequently healed three weeks after the initiation of combined treatment, and the need for diversion colostomy was prevented. Outcome The care process showed the importance of evidence-based practice in the management of infantile haemangioma using advanced technology. We built up an effective collaboration between various healthcare teams and with the family of the patient. The Paediatric nurse played a vital role in the coordination between the health services so that timely treatment and rapid healing could be achieved with minimal sequels for this patient.
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