Chloe's First Surgery

June 4-5, 2007---Chloe has a vascular birthmark which is a tumor called a hemangioma. Let me start by explaining what a hemangioma is. These tumors are benign by cell type but can have serious consequences. Cavernous hemangiomas are wild, jumbled growths of blood vessels fed by numerous tributary arteries (making surgical removal extraordinarily difficult and risky in most cases). This type of hemangioma is not present at birth but is noticeable within the first 18 months of life. They may attain great size and cause significant disfigurement or even impinge on vital organs or the airway. They can be external (on the skin) or internal (in the brain, liver, lungs, etc.). If a person has three or more external hemangiomas, they more than likely have internal ones as well. The external tumors spread across the skin as well as grow into the tissue and raise out from the skin. Color of the tumors begin with pink/red (superficial) and it changes depending on how deep it has grown ( blue, purple, and finally flesh-tone). They can be treated with a laser as soon as they are diagnosed, and early treatment is key as laser becomes less effective if you wait. The laser selects the red and shrinks the vessels so that the result is a less noticeable lesion. Repeated treatments can almost completely remove the superficial component. However, since the laser can only penetrate 1-3mm, it cannot shrink any deep component. Sometimes early treatment will prevent further growth, although deeper portions may still persist and grow. Aside from disfigurement and possible problems caused by sheer size of the birthmark, the tortuous blood vessel channels within the hemangioma cause the formation of platelet clots. These clots can consume platelets so rapidly that the bone marrow cannot keep up with production, and bleeding may develop elsewhere in the body because of severe reduction in the level of platelets in circulation. No one knows what causes them. They occur in 1 out of 100 births (primarily caucasian), 70% of those are located on the face/neck area, they are five times more likely to occur in females than males, and they are often seen in preemies. Chloe is a white female but was not a preemie.

Chloe's "boo-boo" is located on the bridge of her nose and around her left eye. It didn't appear until she was almost a week old. At fist we thought she had scratched herself. It was a thin, flat line shorter than the length of your pinky fingernail. It quickly began to grow longer and wider. By the time she was five weeks old, it had grown to 2.5 cm long, 1.5 cm wide, and was slowly raising out from her face. We could see new growth on it almost daily. When Chloe was 12 weeks old, the hemangioma was 3.8 cm long, 2.5 cm wide, and raised out about 0.5 cm from her face. It is starting to cross the bridge of her nose, moving towards the other eye, and is also blocking one of her tear ducts. We hope that there has been no damage to her vision.

Chloe had her first round of steroid injections/laser treatments at the Vascular Anomalies Center in Little Rock. We had planned to leave Pontotoc at 9:30 a.m. Monday morning. However, as we pulled out of our driveway we noticed that we had a flat tire. Rick aired it up and we drove to the nearest gas station to check the tire pressure. The tire was flat again when we go there, so Rick aired it up again and we drove home. We unloaded all of the luggage from the van into Rick's truck and were on the road at 10:05 a.m. Luckily, we didn't get stuck in traffic because it's a four hour drive to Little Rock and Chloe's appointment was at 2:15 p.m. Your appointment is cancelled if you're late. The consult went well Monday. We have learned that hemangiomas are caused by placental cells that embed themselves under the baby's skin. They also grow intermittently throughout the first ten to twelve months of life; then they stop growing. Some then begin to shrink on their own while others do not change at all. Because of this, she will have another round of laser treatments and steroid injections in August and November. Then in February they will re-evaluate her to determine if we leave it alone, decide if she needs more treatments, do surgery to remove what is left of it, or do reconstructive surgery to remove excess skin/scar if it has completely shrunk. The process to remove the hemangioma could take as little as a year or as long as four years. The doctor just wanted us to be prepared that there is no quick fix and everyone reacts differently to the treatments. The goal is that by age 4, you will not be able to tell that there was ever anything wrong with Chloe.

Her surgery was scheduled for noon Tuesday but they didn't take her back until 12:38 p.m. The doctor called us at 12:48 p.m. to say that the surgery was over and she was in recovery. We left the hospital at 1:15 p.m. It was a very quick procedure and all went well. Even though we had been through minor surgery for one of our children before (Anna Catherine had tubes put in her ears when she was sixteen months old), no parent wants to go through it again. Chloe did very well for a baby who hadn't eaten for six hours before surgery. She never cried or got fussy before the surgery (but mommy did). As expected, Chloe was cranky and very hungry in the recovery room. She is only taking tylenol for pain. The pain and gas should subside after a few days. The surface of the tumor is now black and swollen. There are four bruise spots around the hemangioma where the steroid was injected. One side effect of having the steroid injected so close to the eye is that it can cause blindness. However, the doctor has never had anyone become blind from these treatments. It looks worse now than it did before the surgery but the doctor said that it will get worse before it gets better. We should start to see some changes in about two weeks. The black should begin to fade to pink and the tumor begin to shrink. She can't rub or scratch the area because it could bleed or ulcerate. She can't be in the sun because it would cause the hemangioma to blister, crack and ulcerate (which takes many months to heal and severe scarring). Therefore, we will be spending the summer in the shade with a hat on.