Title Excision of hemangioma
Description A complete excisional biopsy is taken from the lower lip of a 30-year old man
Authors Anders Nattestad og Lars Eriksson
Length 7:52



Introduction
32-year old man with Hemangioma on the lower lip. There is no pain associated with the lesion, but the patient want it removed for esthetic reasons. It was decided to do an excision rather than freezing.

Local anesthesia
Initially local anesthesia is given as infiltrations below the site for the biopsy. The drug of choice is Lidocaine 2% with adrenaline (12,5ug per ml). A total of 1,5 ml is given at varying depth below the biopsy site.

Incision
The incision is done in an elliptic shape with a scalpel. The two sides of the incision will in theory meet deep in the wound and give a v-shape in cross-sectional view. If the biopsy would have been taken more laterally, it is necessary to do a blunt dissection to avoid damage to the peripheral branches of the mental nerve. There will often be numerous glands in the region.

Excision
After the incision, the specimen is excised carefully while holding the specimen with a tissue forceps, such as the Stillies pickup used in this case. The excision can be done both with a scalpel and with a scissor such as the Metzenbaum, which are blunt tissue scissors.

Hemostasis
Before suturing, hemostasis must be accomplished. This is done in this case with electro-coagulation directly onto the bleeding vessels



Suturing
After excision of the specimen, suturing is next. Before suturing check that there are no loose salivary glands in the wound as these will impair the healing. In some cases it is necessary to release the margins with a blunt dissection using a scissor like a Metzenbaum. In this case thaough, that was not necessary. The suturing is done by single sutures with a resorbable synthetic thread (Vicryl).



http://www.askdrehab.com/videos/hemangioma-lavestL.wmv