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      Results of a unilateral lip lift for correction of a vertical disproportion in upper lip vascular anomalies

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          Abstract

          Congenital vascular anomalies most notably hemangiomas involving the lips, especially those which fail to regress, pose a difficult problem both for the surgeon and the patient. These lesions not only discolour the skin but may also distort the shape of the lip. When nonsurgical modalities fail to treat these lesions, surgery is chosen as the next viable step. In this article, we propose a well planned sequential surgical procedure for unilateral lesions. This approach in comparison with previously used procedures produces noticeably better results and fewer complications. During a period of 4 years, we treated 21 patients with vascular anomalies using the unilateral upper lip lift procedure to correct the vertical disproportion of commissures. Using this procedure, we managed to restore the normal form and symmetry of the upper lip in a majority of our patients with less obvious scarring and few complications.

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          Most cited references16

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          Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics.

          Forty-nine specimens from a variety of vascular lesions were analyzed for cellular characteristics. Two major categories of lesions emerged from this investigation: hemangiomas and vascular malformations. This classification and its implications are justified by several considerations. Hemangiomas in the proliferating phase (n = 14) were distinguished by (1) endothelial hyperplasia with incorporation of [3H]thymidine, (2) multilaminated basement membrane formation beneath the endothelium, and (3) clinical history of rapid growth during early infancy. Hemangiomas in the involuting phase (n = 12) exhibited (1) histologic fibrosis and fat deposition, (2) low to absent [3H]thymidine labeling of endothelial cells, and (3) rapid growth and subsequent regression. The endothelium in hemangiomas had many characteristics of differentiation: Weibel-Palade bodies, alkaline phosphatase, and factor VIII production. Vascular malformations (n = 23) demonstrated no tritiated thymidine incorporation and normal ultrastructural characteristics. These lesions were usually noted at birth, grew proportionately with the child, and consisted of abnormal, often combined, capillary, arterial, venous, and lymphatic vascular elements. This cell-oriented analysis provides a simple yet comprehensive classification of vascular lesions of infancy and childhood and serves as a guide for diagnosis, management, and further research.
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            Hemangiomas, vascular malformations, and lymphovenous malformations: classification and methods of treatment.

            A total of 207 patients with hemangiomas, vascular malformations, and lymphovenous malformations were treated by the same surgeon from 1980 to 1990. Thirty-seven patients with true hemangiomas underwent surgical treatment. Only those hemangiomas which caused functional or developmental disturbances or those with complications were treated; many more were allowed to regress spontaneously. Sixty-five patients with low-flow and 16 with high-flow vascular malformations were treated by using a variety of surgical approaches. In low-flow lesions, sclerosant therapy can be extremely effective, either alone, in small lesions, or combined with surgical resection or embolization, in larger lesions. Preoperative embolization and surgical excision are the treatment of choice in high-flow malformations. Twenty-seven patients with lymphovenous malformations had only surgical excision with a high success rate. Sixty-two patients with acquired "senile hemangiomas" underwent a single local excision with excellent results. When indicated, angiography has been of great value as a diagnostic procedure to provide information about the vascular dynamics and the extent of these lesions, although magnetic resonance imaging is now being used more frequently for this purpose. Selective angiography also was used as a therapeutic modality when embolization was part of the treatment protocol. A new classification based on clinical, histologic, and vascular flow characteristics of these lesions has been used to simplify the present nomenclature and to help in selection of the most appropriate treatment. It has the added value of being in the language of the radiologist, who should be a member of the vascular anomalies team.
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              Strawberry hemangioma in preterm infants.

              Of 973 preterm infants, strawberry hemangioma was recorded in 124 during the first year of life, giving an overall frequency of 12.7%. Male:female ratio was 1:1.4. In 96 infants with birth weight below 1000 g, hemangioma occurred in 22 (22.9%), and in the group of very low-birth-weight infants (below 1500 g) the rate was 15.6%. Ninety-four infants had a single hemangioma and three had more than 10 lesions each. With one exception, no treatment was needed, as spontaneous involution started at age 5 to 12 months.
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                Author and article information

                Journal
                Indian J Plast Surg
                IJPS
                Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India
                Medknow Publications (India )
                0970-0358
                1998-376X
                Jan-Jun 2009
                : 42
                : 1
                : 13-17
                Affiliations
                Department of Plastic Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
                Author notes
                Address for correspondence: Dr. Shahriar Loghmani, Department of Plastic Surgery, Alzahra Hospital, Isfahan, Iran E-mail: sh_loghmani@ 123456yahoo.com
                Article
                IJPS-42-13
                10.4103/0970-0358.53006
                2772275
                19881014
                c44ee544-8bda-4312-af10-c987efa099a4
                © Indian Journal of Plastic Surgery

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Article

                Surgery
                macrocheilia,unilateral lip lift,vascular anomalies
                Surgery
                macrocheilia, unilateral lip lift, vascular anomalies

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