Hemangioma Removal

THE NEW YORK HOSPITAL
05-25-95

KO, KANG WEI

249-27-02



PREOPERATIVE DIAGNOSIS: GIANT HEMANGIOMA, LEFT THIGH AND LOWER LEG.

POSTOPERATIVE DIAGNOSIS: SAME.

OPERATION:

1. EXCISION OF MASSIVE HEMANGIOMA, LEFT THIGH AND LEFT LOWER LEG.
2. SPLIT THICKNESS SKIN GRAFT GREATER THAN 200 SQ. CENTIMETERS.

SURGEON: LLOYD HOFFMAN, M.D.

ASSISTANT: SCHWARTZ, M.D.

ANESTHESIA: GENERAL ENDOTRACHEAL ANESTHESIA.

ANESTHESIOLOGIST:

INDICATIONS:
The patient is a 17 year old Asian male who has a massive hemangioma of the left posterior thigh and posterior calf as well as the popliteal fossa.  This hemangioma has been present since birth.  It was treated with herbal wraps and the patient subsequently developed a burn over the skin.  This area continually becomes infected and has often bled.  MRI reveals a deep hemangioma and the angiogram revealed normal vessels.

PROCEDURE:
The patient was taken to the Operating Room where he underwent extensive preoperative preparation including Foley catheterization, IV lines, warming blankets and he was rotated into position following the induction of endotracheal anesthesia. The patient is a massive individual weighing greater than 112 kilos.

The entire leg and left upper thigh and buttocks were prepped and draped in the usual fashion.  Consideration was given to the latissmus dorsi flap and this area was prepped in as well.  A tourniquet was applied to the left upper thigh and the left leg was exsanguinated as fully as possible.  The tourniquet was inflated to 350 mmHg.

Incision was designed involving the medial aspect of the upper thigh extending inferiorly encompassing a large ellipse of involved skin and then proceeding inferiorly to a straight line again.  The incision was made using a 10 blade and skin flaps were elevated.  Even the normal appearing skin was involved with the hemangiomatous component.  Extensive dissection was carried out sharply and bluntly to remove hemangioma from between muscle groups as well as fascia.  The semimembranosus and semitendonosus and gracilis muscles were dissected out as the popliteal fossa was crossed and the gastroc muscles came into view.  The fascia was removed with the specimen and hemostatis was achieved.  Following excision of this large mass and submission to Pathology, the remaining skin was trimmed using the scissors.

The defect measured approximately 12 centimeters in width by 48 centimeters in length.  The decision was not to use the flap and skin graft this area.  The dermis was then tacked down to muscle and skin harvested with the Padgett dermatome from the upper thigh and buttock area.

The skin was meshed and secured with staples and wet clips.  Carefully molded splint was prepared and the graft secured with moist cotton and Xeroform.

The patient tolerated this procedure well and was transferred to the Recovery area in stable condition.  The sponge and instrument counts were correct.  The estimated blood loss was 200 cc.

DICTATED BY: LLOYD HOFFMAN, M.D.

LH/FVB/RR

TAPE: 6714

D: 05-26-95

T: 05-31-95

531NY03.FVB